Can Frailty and Sarcopenia Be Mitigated in Esophagectomy Candidates?

Abstract

Sarcopenia and frailty have shown to be associated with diminished functional capacity and increased post-operative complications resulting in prolonged recovery in patients undergoing esophagectomy. Traditionally, enhanced recovery programs in esophagectomy have implemented strategies aimed to mitigate their effect by improving functional status and recovery through multimodal approaches focusing on the intra- and post-operative phase. Recently, the concept of ``prehabilitation'', which consists of pre-operative multimodal programs including exercise and nutrition to enhance functional capacity and withstand the stress of surgery, has garnered interest. Recently published studies on prehabilitation in esophagogastric cancer surgery have shown promising results in improved functional capacity. While there is currently limited data on its effect in esophagectomy, we recommend that esophagectomy candidates undergo a multimodal prehabilitation program to improve functional capacity, hence mitigating the effect of sarcopenia and frailty, as evidenced by extrapolated results from larger major abdominal and colorectal surgery studies. Nonetheless, further studies are needed and results of multiple ongoing trials will soon provide a better assessment of whether an increase in preoperative performance status translates to meaningful improvements in clinical and oncological outcomes.