Geriatric co-managed prehabilitation before esophagectomy in patients aged ≥ 65 years with esophageal cancer: a prospective feasibility study with matched historical controls.

Authors

Linus Alexander Völker, Emily Haak, Hans Schlößer, Christiane J Bruns, Pauline Schumacher, Wolfgang Schröder, Paul Thomas Brinkkoetter

Published in

Langenbeck's archives of surgery. Volume 411. Issue 1. Sep 29, 2026. Epub Sep 29, 2026.

Abstract

Older patients undergoing esophagectomy remain at high risk for perioperative morbidity. This study evaluated the feasibility, safety and adherence of a multimodal prehabilitation program integrated with geriatric co-management in patients aged ≥ 65 years scheduled for transthoracic esophagectomy and explored perioperative outcomes.
In this single-center prospective feasibility study, patients aged ≥ 65 years scheduled for transthoracic esophagectomy completed a 4-week home-based program of endurance, respiratory, resistance and balance training combined with comprehensive geriatric assessment and medication optimization. Feasibility outcomes were retention, adherence and data completeness. Perioperative outcomes were compared with a 2:1 matched historical control cohort using cluster-robust linear regression for continuous outcomes and Firth penalized logistic regression for binary outcomes.
Twenty-six patients were enrolled; 22 completed the intervention and were matched to 42 control records. At the first check-in 61.5% reported complete and 84.6% complete or mostly complete adherence; documentation was missing for 69.2% at the second. Despite matching, controls had more favorable performance status (p = 0.023) and comorbidity burden (p = 0.014). Postoperative complications, anastomotic leakage, hospital mortality and length of stay did not differ significantly. Intensive care unit (ICU) readmission was lower after prehabilitation (4.5% vs. 26.2%; odds ratio 0.19, 95% confidence interval 0.02-0.90; p = 0.035), but not after adjustment for surgical approach (adjusted odds ratio 0.30; p = 0.172).
Multimodal prehabilitation with geriatric co-management was feasible and safe in this population. Overall postoperative morbidity was unchanged. The lower ICU readmission rate did not withstand adjustment and is hypothesis-generating requiring an adequately powered randomized trial. Future programs need more robust adherence monitoring.
ClinicalTrials.gov NCT05167682, registered 9 December 2021, retrospectively registered.

PMID:
42809113
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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