Delivering Multimodal Prehabilitation in the Neoadjuvant Window Before Esophagogastric Cancer Surgery: Home-Based Models, Digital Health, and Implementation – A Narrative Review

This is the authors' abstract. We don't add key points for this paper.

Esophagectomy and gastrectomy for esophagogastric cancer are among the most physiologically demanding oncological operations and carry high rates of postoperative morbidity. Because neoadjuvant chemotherapy or chemoradiotherapy now precedes surgery in most patients with locally advanced disease, the preoperative interval offers an opportunity to intervene through multimodal prehabilitation, combining aerobic and resistance exercise, inspiratory muscle training, nutritional optimization, and psychological support. This narrative review synthesizes the rationale and current evidence for prehabilitation during the neoadjuvant window and, in particular, examines how it can be delivered in practice. Prehabilitation consistently improves preoperative functional capacity and respiratory muscle strength, and inspiratory muscle training is associated with fewer postoperative pulmonary complications, although effects on overall morbidity, length of stay, and mortality remain inconsistent. Beyond efficacy, the review foregrounds delivery and implementation: supervised hospital-based programmes are resource-intensive and geographically limiting, whereas home-based and digitally supported models — using smartphone applications, wearable sensors, and telehealth contact — offer a scalable alternative, with early evidence that home-based delivery may be comparable to supervised care. Technology-enabled prehabilitation raises its own questions of access and equity, including digital literacy and connectivity, that determine whether it narrows or widens existing disparities. Prehabilitation timed to the neoadjuvant window is a biologically plausible, feasible, and low-risk strategy to improve preoperative fitness; its translation into routine esophagogastric cancer care now depends as much on delivery model, technology, and implementation as on defining optimal clinical content, and standardized, adequately powered trials are needed to confirm benefit.