Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Controlled Clinical Trial
. 2025 Jun;131(8):1508-1520.
doi: 10.1002/jso.28079. Epub 2025 Jan 29.

Prehabilitation of Patients With Oesophageal Malignancy Undergoing Peri-Operative Treatment (Pre-EMPT): Outcomes From a Prospective Controlled Trial

R Bott  1 , J Zylstra  1   2 , W Knight  1 , G P Whyte  2   3 , A M Lane  4 , C Moss  5 , M Browning  6 , J Lagergren  1   5   7 , M Van Hemelrijck  5 , A R Davies  1   5 ; Pre‐EMPT study group including the following co‐authors
Collaborators, Affiliations
Controlled Clinical Trial

Prehabilitation of Patients With Oesophageal Malignancy Undergoing Peri-Operative Treatment (Pre-EMPT): Outcomes From a Prospective Controlled Trial

R Bott et al. J Surg Oncol. 2025 Jun.

Abstract

Background: The Pre-EMPT study aimed to determine if structured exercise could reduce length of stay, post-operative complications and improve fitness and health-related quality of life (HQRL) in patients undergoing neoadjuvant chemotherapy (NAC) and oesophagectomy.

Methods: A prospective non-randomised trial compared a standard care pathway (control) to a structured prehabilitation exercise programme (intervention) commenced before NAC and surgery for oesophageal adenocarcinoma. Length of hospital stay and post-operative complications were recorded. Cardiopulmonary exercise testing (CPEX), body composition analyses, lymphocyte levels and HRQL questionnaires were performed at multiple time points.

Results: Median length of stay was similar in both groups. There were 6 versus 11 complications observed (intervention vs control p = 0.086). Cardio-pulmonary fitness (VO2peak) declined after NAC, but less in the intervention group (intervention -13.54% vs control -21.40%, p = 0.02). Body composition improved in the intervention group (FMi/FFMi -5.5% intervention, 10.7% control p = 0.043). Performance, cognitive, sleep and emotional function scores improved following NAC in the intervention group. Lymphocyte subsets increased in the intervention group compared to the control group after chemotherapy (p = 0.034). Chemotherapy response was improved in the intervention group (p = 0.022).

Conclusion: A structured exercise programme may mitigate cardiopulmonary deconditioning, reduce sarcopenia and offset lymphopenia, during chemotherapy, in patients undergoing NAC and oesophagectomy.

Keywords: cardiopulmonary exercise testing; health‐related quality of life; neoadjuvant chemotherapy; oesophageal adenocarcinoma; prehabilitation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pre‐EMPT Trial Flowchart.
Figure 2
Figure 2
EORTC cognitive, performance and emotional functioning and quality of life at baseline, post NAC and pre‐surgery.
See this image and copyright information in PMC

References

    1. Cunningham D., Allum W. H., Stenning S. P., et al., “Perioperative Chemotherapy Versus Surgery Alone for Resectable Gastroesophageal Cancer,” New England Journal of Medicine 355, no. 1 (2006): 11–20, 10.1056/NEJMoa055531. - DOI - PubMed
    1. van Hagen P., Hulshof M. C. C. M., van Lanschot J. J. B., et al., “Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer,” New England Journal of Medicine 366, no. 31 (2012): 2074–2084. - PubMed
    1. Al‐Batran S. E., Homann N., Pauligk C., et al., “Perioperative Chemotherapy With Fluorouracil Plus Leucovorin, Oxaliplatin, and Docetaxel Versus Fluorouracil or Capecitabine Plus Cisplatin and Epirubicin for Locally Advanced, Resectable Gastric or Gastro‐Oesophageal Junction Adenocarcinoma (FLOT4): A Randomised, Phase 2/3 Trial,” Lancet (London, England) 393, no. 10184 (2019): 1948–1957, 10.1016/S0140-6736(18)32557-1. - DOI - PubMed
    1. Jack S., West M. A., Raw D., et al., “The Effect of Neoadjuvant Chemotherapy on Physical Fitness and Survival in Patients Undergoing Oesophagogastric Cancer Surgery,” European Journal of Surgical Oncology (EJSO) 40, no. 10 (2014): 1313–1320, 10.1016/J.EJSO.2014.03.010. - DOI - PubMed
    1. Thomson I. G., Wallen M. P., Hall A., et al., “Neoadjuvant Therapy Reduces Cardiopulmunary Function in Patients Undegoing Oesophagectomy,” International Journal of Surgery 53 (2018): 86–92, 10.1016/J.IJSU.2018.03.030. - DOI - PubMed

Publication types

MeSH terms

Supplementary concepts