The Usefulness of Nutritional Exercise Therapy During Preoperative Adjuvant Treatment for Esophageal Cancer

Background Complications after esophageal cancer surgery have been reported to affect long-term prognosis. Sarcopenia is a risk factor for postoperative complications. In our previous study, we found that the Skeletal Muscle Index (SMI) decreased and the number of sarcopenia cases increased before and after preoperative chemotherapy. In addition, overall complications increased in patients with sarcopenia, and sarcopenia was an independent predictor of postoperative complications. Therefore, we examined the effect of enhanced active nutritional exercise during preoperative adjuvant therapy on changes in SMI and postoperative outcomes. Methods Twenty-four patients scheduled for esophagectomy after preoperative chemotherapy and consent were treated with nutritional exercise therapy from 2020 to 2022 (RN group). 107 patients from 2015 to 2018 were selected, and 48 patients matched 1:2 were considered the control group. Nutritional therapy consisted of supplements high in BCAAs, especially leucine, and vitamin D, taken during preoperative chemotherapy. Exercise therapy consists of six exercise programs developed in consultation with a physical therapist and performed as independent training. SMI and various nutritional indices and postoperative complications were compared between the two groups. Furthermore, the relationship between sarcopenia and long-term prognosis was investigated. Results SMI increased 3.8% (median) after chemotherapy in the RN group, but decreased 4.7% in the C group (P < 0.001). PNI and Alb values showed similar trends. The number of complications with CD3a was significantly reduced from 58.3% in the C group to 25% in the RN. Furthermore, a comparison of nutritional indices at 6 months postoperatively showed that SMI decreased 10.1% in the C group compared to 4.1% in the RN. In the postoperative overall survival analysis, nine deaths were observed in the control group at the observation period of 2 years, while no deaths occurred in the RN. Conclusion Nutritional and exercise therapy during preoperative chemotherapy for esophageal cancer improves nutritional status during preoperative treatment and short-term postoperative outcomes. It may also improve long-term prognosis.