The road to recovery starts before the journey: Prehabilitation strategies for esophageal cancer patients—A narrative review

Patients with esophageal and gastroesophageal junction cancer face high rates of malnutrition, reported between 22% and 73%. Despite these alarming numbers, less than half of those patients received nutritional evaluation or intervention by a registered dietitian. Perioperative nutrition interventions and structured prehabilitation programs have been associated with improved nutritional status, better overall health, and enhanced tolerance of surgery and recovery. The objective of this narrative review is to synthesize current evidence (from 2017 to 2026) on nutritional and exercise strategies for patients with a diagnosis of esophageal and gastroesophageal junction cancers, with particular emphasis on prehabilitation interventions aimed to improve perioperative outcomes. We follow a broad approach to patient care, extending beyond traditional “prehabilitation” to include interventions before and during neoadjuvant therapy as well as after surgery, and during periods of surveillance and adjuvant therapy. Across the included studies, the combination of exercise and nutritional interventions seem to be associated with improvements in nutritional status, functional capacity, and postoperative recovery. Within this paradigm, ERAS pathways continue to play a fundamental role to standardize approaches for perioperative patient care. Finally, although our review highlights the benefits of nutrition and exercise interventions during oncologic care, further research is needed to standardize approaches and clarify which strategies offer the greatest benefit across the oncologic journey.