{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:56:22Z","timestamp":1790675782317,"version":"4.1.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100014419","name":"EIT Health","doi-asserted-by":"publisher","award":["19365"],"award-info":[{"award-number":["19365"]}],"id":[{"id":"10.13039\/100014419","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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\u2009\u2265\u200965 years scheduled for transthoracic esophagectomy and explored perioperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center prospective feasibility study, patients aged\u2009\u2265\u200965 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023) and comorbidity burden (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014). 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\u20130.90;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035), but not after adjustment for surgical approach (adjusted odds ratio 0.30;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.172).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT05167682, registered 9 December 2021, retrospectively registered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-026-04285-y","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:04:46Z","timestamp":1790647486000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geriatric co-managed prehabilitation before esophagectomy in patients aged\u2009\u2265\u200965 years with esophageal cancer: a prospective feasibility study with matched historical controls"],"prefix":"10.1007","volume":"411","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-6128","authenticated-orcid":false,"given":"Linus Alexander","family":"V\u00f6lker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Haak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1304-7719","authenticated-orcid":false,"given":"Hans","family":"Schl\u00f6\u00dfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6590-8181","authenticated-orcid":false,"given":"Christiane J.","family":"Bruns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Schumacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8700-069X","authenticated-orcid":false,"given":"Wolfgang","family":"Schr\u00f6der","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4287-2080","authenticated-orcid":false,"given":"Paul Thomas","family":"Brinkkoetter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"4285_CR1","doi-asserted-by":"publisher","first-page":"e386","DOI":"10.1097\/SLA.0000000000004550","volume":"276","author":"BF Kingma","year":"2022","unstructured":"Kingma BF, Van Der Grimminger PP, Van Det MJ, Kouwenhoven EA, Chao Y-K, Tsai C-Y, Fuchs HF, Bruns CJ, Sarkaria IS et al (2022) Worldwide techniques and outcomes in robot-assisted minimally invasive esophagectomy (RAMIE): results from the multicenter international registry. 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He reports travel support and speaker fees from Sanofi, Alexion, Bayer, CSL Vifor and Stada. These activities are unrelated to perioperative care, surgical practice, prehabilitation, esophageal cancer, or the interventions and outcomes investigated in the present study.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No previously published figures, tables, questionnaires or text passages are reproduced in this manuscript. Standardized clinical instruments used in the study (DASI, GPAQ, NRS 2002, Ogilvie dysphagia score, CFS, TUG, DEMMI, MMSE, GDS, SF-36, mGPS) are cited in the Material and methods section but are not reproduced. Instruments were licensed when applicable.","order":6,"name":"Ethics","label":"Permissions","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"253"}}