Nutritional Prehabilitation and Esophagectomy

The safety and long-term outcomes of surgical treatment for esophageal cancer have improved due to advances in minimally invasive surgical and perioperative management techniques. However, simultaneously, the number of surgical candidates and number of patients with preoperative malnutrition, sarcopenia, and frailty are also increasing among patients with esophageal cancer. Although there is little evidence regarding the usefulness of perioperative nutritional management in patients with esophageal cancer, early intervention before surgery is considered desirable, especially in high-risk cases, and several studies have shown the usefulness of postoperative nutritional support through tube feeding at home. It has been suggested that perioperative physical rehabilitation, so called prehabilitation, especially with continued intervention during the course of neoadjuvant therapy, contributes not only to the physical functioning, but also to treatment tolerability and reduction in the incidence of postoperative complications. Esophageal cancer surgery has a significant impact not only on physical function but also on swallowing function, and it has been suggested that the risk of poor nutritional intake and aspiration can be reduced by functional training and instructions for swallowing using the chin-down maneuver. We believe that it is important to provide appropriate and continuous intervention based on assessment of the risk with objective indicators.