Exploring the impact of physical exercise regimens on health-related quality of life following oesophageal or gastric cancer surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract

Purpose: To assess the effectiveness and adverse events of postoperative physical exercise on health-related quality of life (HRQL) in patients who have undergone surgery for oesophageal or gastric cancer.

Methods: We conducted a systematic review and meta-analysis and reported it according to the preferred reporting items for systematic reviews and meta-analyses. (PRISMA) guidelines. Randomised controlled trials (RCT) that investigated HRQL factors following physical exercise interventions in patients undergoing oesophageal or gastric cancer surgery were included. Studies including participants who had undergone oesophagectomy or gastrectomy for cancer, of either sex and were 18 years or older were included. Participants with other cancers were excluded. Medline, Embase, CINAHL, Cochrane Library, PEDro, and trial registries were searched for studies from inception until February 2025. Results were synthesised using meta-analyses. Two independent reviewers assessed the risk of bias using the Cochrane risk of bias tool 2.0, and the grading of recommendations assessment, development and evaluation (GRADE) was used to evaluate the overall certainty of the evidence. PROSPERO ID CRD42022358493.

Results: Three studies enrolling 284 patients undergoing oesophagectomy were included, of which two were assessed at high risk of bias and one at some concerns. The global quality of life score from the European Organisation for Research and Rreatment of Cancer (EORTC) quality of life questionnaire Cancer QLQ-C30 was used to assess HRQL in all the included studies. The score ranges from 0 to 100, with higher scores indicating a better HRQL. Physical exercise therapy had no discernible impact on HRQL compared to the control group (mean difference 0.77 [95% CI -4.36, 5.90]. However, the quality of evidence was very low, which should be considered when interpreting the results as they can differ substantially from the true effects.

Conclusion: We found a significant lack of information about the effects of post-surgery physical exercise compared to standard care in patients who have undergone oesophagectomy or gastrectomy for cancer. Based on the current very low certainty evidence, the effectiveness on HRQL and the safety of postoperative physical exercise in patients treated with oesophagectomy for cancer is uncertain. We found no studies investigating gastric cancer and exercise.

Keywords: Cancer; Eesophageal; Exercise; Gastric; Stomach neoplasm; Symptoms.

Fig. 1

Flow diagram of search strategy. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/

Fig. 2

Risk of bias assessment of the individual included studies

Fig. 3

Summary of risk of bias judgments of the included studies for HRQL. Figures 2 and 3 were created using the Robvis web app. 1. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualising risk-of-bias assessments. Research Synthesis Methods. 2020

Fig. 4

Random effect model. Effect of exercise on health-related quality of life. CI, confidence interval; df, degrees of freedom; IV, inverse variance; SD, standard deviation