P1.081. The Effect of Pre-Rehabilitation During Neoadjuvant Chemotherapy in Esophageal Cancer
Abstract
Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies The standard treatment for resectable advanced esophageal squamous cell carcinoma is neoadjuvant chemotherapy (NAC) followed by surgery. Rehabilitation is recommended during NAC; however several adverse events often hinder its completion. This study examined the impact of rehabilitation completion rates during NAC on postoperative complications. We retrospectively analyzed 111 patients who had esophagectomy after NAC for thoracic esophageal squamous cell carcinoma between January 2017 and December 2024. Preoperative chemotherapy was selected as either DCF (Docetaxel + Cisplatin (CDDP) + 5-FU) therapy or CF (CDDP + 5-FU) therapy in accordance with the Esophageal cancer practice guideline 2022. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events v5.0. All patients underwent radical esophagectomy via a right thoracic approach. Rehabilitation was defined as 20-minute sessions, prescribed as two units per day. Completion rate = (units performed ÷ units prescribed) × 100. Based on a 67.5% cutoff from ROC analysis, patients were divided into insufficient (Group I, n = 46) and sufficient (Group S, n = 65) groups. Clinical and pathological factors were compared. Patients in Group I experienced grade 3 or higher adverse events more frequently than in Group S (65.2% vs. 44.6%, p = 0.036). Group S had a superior relative dose intensity for both 5-FU and CDDP (median 5-FU 80.0 vs. 90.0, p = 0.006; CDDP 75.0 vs. 86.7, p = 0.014). Patients in Group S showed a lower weight than in Group I (median 54.7 kg vs. 58.0 kg, p = 0.032). Postoperative pneumonia (30.4% vs. 7.7%, p = 0.004) and atelectasis (28.3% vs. 7.7%, p = 0.008) were significantly more frequent in Group I than in Group S. Multivariate analysis identified rehabilitation completion as an independent factor reducing postoperative pneumonia (OR 0.177, p = 0.003, 95% CI 0.057–0.548). Completion of the prehabilitation program during NAC may prevent postoperative pneumonia after esophagectomy. These findings may help determine the optimal supportive care during NAC.