Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery

11511 Background: Older cancer patients value functional outcomes as much as survival but surgical studies lack functional recovery (FR) data. The international, multicenter GOSAFE study (ClinicalTrials.gov NCT03299270) aims to evaluate patients’ quality of life (QoL)and FR after cancer surgery and to assess predictors of FR. Methods: GOSAFE prospectively collects functional and clinical data before and after major elective cancer surgery on senior adults (≥70 years). Surgical outcomes are recorded (30 days, 90 days, and 180 dayspost-operatively) with QoL(EQ-5D-3L) and FR (Activities of Daily Living (ADL) + Timed Up and Go (TUG) + MiniCog), 28centers are prospectively enrolling patients; accrual ends February 2019. Results: 643 patients underwent major cancer surgery with curative(94%) or palliative (6%) intent (February 2017-September 2018). Median age was 78(range 70-94); 51.6% males, ASA III-IV 52%. Patients dependent (ADL < 5) were 8%. Frailty was detected by G8 > 14 in 32% and fTRST≥2 in 36% of patients. 639 (99%) lived at home, 32% lived alone, and 88% were able to go out. Major comorbidities (CCI > 6) were detected in 36% and 22% had cognitive impairment according to MiniCog (5% self-reported). 26% had > 3 kg weight loss, 30% were hospitalized in the last 90 days, 45% had ≥3 medications (6% none). For 471 patients, a 90-day comprehensive evaluation was available. Postoperative morbidity was 42% (30 day) and 63.3% (90 day), but Clavien-Dindo III-IV complications were only 11.2% and 17.6%. 90-day mortality was 7.4% (5% 30-day). QoL improved 90 days after surgery (mean EQ-5D index from 0.76 to 0.80). Patients with EQ-5D VAS score > 60 raised from 73.9% at baseline to 82.8% at 90 days. 29% had complete FR (ADL score > 4, MiniCog > 2, TUG < 20). Decreased functional capacity was seen in 23.4% of patients alive at 90-days. Conclusions: GOSAFE is the largest prospective study on older cancer patients undergoing major surgery. Interim analysis reports decreased functional capacity in a quarter of patients. The study will allow clinicians to associate clinical outcomes with individual factors of the preoperative assessment and create a user-friendly tool to predict outcomes that matter to patients.

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ASO Visual Abstract: Robotic Techniques in Esophagogastric Cancer Surgery: An Assessment of Short- and Long-Term Clinical Outcomes

Annals of Surgical Oncology ◽

10.1245/s10434-021-11182-9 ◽

2022 ◽

Author(s):

Sivesh K. Kamarajah ◽

Ewen A. Griffiths ◽

Alexander W. Phillips ◽

Jelle Ruurda ◽

Richard van Hillegersberg ◽

...

Keyword(s):

Clinical Outcomes ◽

Cancer Surgery ◽

Esophagogastric Cancer ◽

Short And Long Term

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Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd013259 ◽

2019 ◽

Author(s):

Stefan J van Rooijen ◽

Charlotte JL Molenaar ◽

Hugo JP Fokkenrood ◽

Rudi MH Roumen ◽

Gerrit D Slooter

Keyword(s):

Quality Of Life ◽

Colorectal Cancer ◽

Postoperative Complications ◽

Functional Capacity ◽

Cancer Surgery ◽

Improve Quality ◽

Colorectal Cancer Surgery

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Outcomes of Esophagogastric Cancer Surgery during eight Years of Surgical Auditing by the Dutch Upper Gastrointestinal Cancer Audit (DUCA)

Annals of Surgery ◽

10.1097/sla.0000000000005116 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Daan M. Voeten ◽

Linde A. D. Busweiler ◽

Leonie R. van der Werf ◽

Bas P. L. Wijnhoven ◽

Rob H. A. Verhoeven ◽

...

Keyword(s):

Gastrointestinal Cancer ◽

Cancer Surgery ◽

Upper Gastrointestinal Cancer ◽

Esophagogastric Cancer ◽

Upper Gastrointestinal

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Quality Assurance Compound Level Metrics in Esophagogastric Cancer Surgery: Proof by Prognosis Rather Than Postoperative Mortality

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.1294 ◽

2019 ◽

Vol 229 (4) ◽

pp. e203

Author(s):

Arfon G. Powell ◽

David Robinson ◽

Chris Brown ◽

Luke Hopkins ◽

Richard J. Egan ◽

...

Keyword(s):

Quality Assurance ◽

Postoperative Mortality ◽

Cancer Surgery ◽

Esophagogastric Cancer

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Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial

British Journal of Anaesthesia ◽

10.1093/bja/aex250 ◽

2017 ◽

Vol 119 (5) ◽

pp. 900-907 ◽

Cited By ~ 14

Author(s):

E.P.M. de Almeida ◽

J.P. de Almeida ◽

G. Landoni ◽

F R B G Galas ◽

J.T. Fukushima ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Functional Capacity ◽

Controlled Trial ◽

Early Mobilization ◽

Cancer Surgery ◽

Randomized Controlled

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Robotic Techniques in Esophagogastric Cancer Surgery: An Assessment of Short- and Long-Term Clinical Outcomes

Annals of Surgical Oncology ◽

10.1245/s10434-021-11082-y ◽

2021 ◽

Author(s):

Sivesh K. Kamarajah ◽

Ewen A. Griffiths ◽

Alexander W. Phillips ◽

Jelle Ruurda ◽

Richard van Hillegersberg ◽

...

Keyword(s):

Gastric Cancer ◽

Robotic Surgery ◽

Open Surgery ◽

High Volume ◽

The United States ◽

Cancer Surgery ◽

Term Survival ◽

Long Term Survival ◽

Esophagogastric Cancer

Abstract Background Robotic esophagogastric cancer surgery is gaining widespread adoption. This population-based cohort study aimed to compare rates of textbook outcomes (TOs) and survival from robotic minimally invasive techniques for esophagogastric cancer. Methods Data from the United States National Cancer Database (NCDB) (2010–2017) were used to identify patients with non-metastatic esophageal or gastric cancer receiving open surgery (to the esophagus, n = 11,442; stomach, n = 22,183), laparoscopic surgery (to the esophagus [LAMIE], n = 4827; stomach [LAMIG], n = 6359), or robotic surgery (to the esophagus [RAMIE], n = 1657; stomach [RAMIG], n = 1718). The study defined TOs as 15 or more lymph nodes examined, margin-negative resections, hospital stay less than 21 days, no 30-day readmissions, and no 90-day mortalities. Multivariable logistic regression and Cox analyses were used to account for treatment selection bias. Results Patients receiving robotic surgery were more commonly treated in high-volume academic centers with advanced clinical T and N stage disease. From 2010 to 2017, TO rates increased for esophageal and gastric cancer treated via all surgical techniques. Compared with open surgery, significantly higher TO rates were associated with RAMIE (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.27–1.58) and RAMIG (OR 1.30; 95% CI 1.17–1.45). For esophagectomy, long-term survival was associated with both TO (hazard ratio [HR 0.64, 95% CI 0.60–0.67) and RAMIE (HR 0.92; 95% CI 0.84–1.00). For gastrectomy, long-term survival was associated with TO (HR 0.58; 95% CI 0.56–0.60) and both LAMIG (HR 0.89; 95% CI 0.85–0.94) and RAMIG (HR 0.88; 95% CI 0.81–0.96). Subset analysis in high-volume centers confirmed similar findings. Conclusion Despite potentially adverse learning curve effects and more advanced tumor stages captured during the study period, both RAMIE and RAMIG performed in mostly high-volume centers were associated with improved TO and long-term survival. Therefore, consideration for wider adoption but a well-designed phase 3 randomized controlled trial (RCT) is required for a full evaluation of the benefits conferred by robotic techniques for esophageal and gastric cancers.

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