{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:45:27Z","timestamp":1792089927614,"version":"4.4.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T00:00:00Z","timestamp":1701129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,29]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Esophagectomy for esophageal cancer is associated with high morbidity. It remains unclear whether prehabilitation, a strategy aimed at optimizing patients\u2019 physical and mental functioning prior to surgery, improves postoperative outcomes. A systematic review and meta-analysis was conducted to evaluate the effect of prehabilitation on post-operative outcomes after esophagectomy. Data sources included Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PEDro, with information from 1 January 2000 to 5 August 2023. The analysis included randomized controlled trials and observational studies that compared prehabilitation interventions to standard care prior to esophagectomy. A random effects model was used to generate a pooled estimate for pairwise meta-analysis, meta-analysis of proportions, and meta-analysis of means. A total of 1803 patients were included with 584 in randomized controlled trials (RCTs) and 1219 in observational studies. In the randomized evidence, there were no significant differences between prehabilitation and control in the odds of postoperative pneumonia (15.0 vs. 18.9%, odds ratio (OR) 1.06 [95% confidence interval (CI): 0.66;1.72]) or pulmonary complications (14 vs. 25.6%, OR 0.68 [95% CI: 0.32;1.45]). In the observational data, there was a reduction in both postoperative pneumonia (22.5 vs. 32.9%, OR 0.48 [95% CI: 0.28;0.83]) and pulmonary complications (26.1 vs. 52.3%, OR 0.35 [95% CI: 0.17;0.75]) with prehabilitation. Hospital and intensive care unit length of stay (days), operative mortality, and severe complications (Clavien-Dindo\u2009\u2265\u20093) did not differ between groups in both the randomized data and observational data. Prehabilitation demonstrated reductions in postoperative pneumonia and pulmonary complications in observational studies, but not RCTs. The overall certainty of these findings is limited by the low quality of the available evidence.<\/jats:p>","DOI":"10.1093\/dote\/doad066","type":"journal-article","created":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T12:15:53Z","timestamp":1700050553000},"source":"Crossref","is-referenced-by-count":37,"title":["Does prehabilitation before esophagectomy improve postoperative outcomes? A systematic review and meta-analysis"],"prefix":"10.1093","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9184-4510","authenticated-orcid":false,"given":"Kevin R","family":"An","sequence":"first","affiliation":[{"name":"Department of Epidemiology , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Harvard University , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY , USA"},{"name":"Division of Cardiac Surgery , Department of Surgery, , Toronto, ON , Canada"},{"name":"University of Toronto , Department of Surgery, , Toronto, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Seijas","sequence":"additional","affiliation":[{"name":"Department of Epidemiology , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Harvard University , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Division of Rehabilitation , Faculty of Health Sciences and Medicine, , Lucerne , Switzerland"},{"name":"University of Lucerne , Faculty of Health Sciences and Medicine, , Lucerne , Switzerland"},{"name":"Ageing , Functioning Epidemiology, and Implementation, , Nottwil , Switzerland"},{"name":"Swiss Paraplegic Research , Functioning Epidemiology, and Implementation, , Nottwil , Switzerland"},{"name":"Department of Physical and Rehabilitation Medicine , Rehabilitation in Health Research Group, , Medellin , Colombia"},{"name":"University of Antioquia , Rehabilitation in Health Research Group, , Medellin , Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S","family":"Xu","sequence":"additional","affiliation":[{"name":"Division of General Surgery , Department of Surgery, , Toronto, ON , Canada"},{"name":"University of Toronto , Department of Surgery, , Toronto, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Gr\u00fc\u00dfer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Harvard University , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Department of Anesthesiology, University Hospital RWTH Aachen , Aachen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sapna","family":"Humar","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine, McMaster University , Hamilton, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amabelle A","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Epidemiology , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Harvard University , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Division of Pediatric Surgery , Department of Surgery, , Manila , The Philippines"},{"name":"University of the Philippines-Philippine General Hospital , Department of Surgery, , Manila , The Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvee","family":"Turk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Harvard University , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Division of Plastic & Reconstructive Surgery , Department of Surgery, Keck School of Medicine, , Los Angeles, CA , USA"},{"name":"University of Southern California , Department of Surgery, Keck School of Medicine, , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koushik","family":"Kasanagottu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Harvard University , Harvard T.H. Chan School of Public Health, , Boston, MA , USA"},{"name":"Division of General Medicine , Department of Medicine, Beth Israel Deaconess Medical Center, , Harvard University, Boston, MA , USA"},{"name":"Harvard Medical School , Department of Medicine, Beth Israel Deaconess Medical Center, , Harvard University, Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talal","family":"Alzghari","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaldo","family":"Dimagli","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery , Department of Surgery, St. Joseph\u2019s Health Centre, , Toronto, ON , Canada"},{"name":"University of Toronto , Department of Surgery, St. Joseph\u2019s Health Centre, , Toronto, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Villena-Vargas","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Papatheodorou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology , Harvard T.H. 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