156: PHYSIOTHERAPY REGIMENS IN ESOPHAGECTOMY AND GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

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Abstract Background and aim Esophageal and gastric cancer surgery are associated with considerable morbidity, specifically postoperative pulmonary complications (PPC), potentially accentuated by underlying challenges with malnutrition and cachexia affecting respiratory muscle mass. Physiotherapy regimens aim to increase the respiratory muscle strength and may prevent postoperative morbidity. This review and meta-analysis is to assess the impact of physiotherapy regimens following esophagectomy or gastrectomy. Methods An electronic literature search was performed in MEDLINE, EMBASE, CENTRAL, CINAHL and Pedro databases, to identify articles evaluating the effect of physiotherapy interventions following esophagectomy or gastrectomy. A meta-analysis was performed to assess the impact of prehabilitation and peri- or postoperative rehabilitation on the functional capacity, incidence of PPC and postoperative morbidity, in-hospital mortality rate, the Length of Hospital Stay (LOS) and the Health-Related Quality of Life (HRQoL). Results Seven RCTs and 7 cohort studies assessing prehabilitation totalling 960 patients, and 5 RCTs and 5 cohort studies assessing peri- or postoperative physiotherapy with 703 total patients, were included. Prehabilitation resulted in a lower incidence of postoperative pneumonia and morbidity (Clavien-Dindo score > II). No significant difference was observed in functional exercise capacity, and in-hospital mortality following prehabilitation. Meanwhile, peri- or postoperative rehabilitation resulted in a lower incidence of pneumonia, a shorter LOS and better HRQoL scores for dyspnea and physical functioning, while no differences were found for the QoL summary score, global health status, fatigue and pain scores. Conclusion Our meta-analysis shows that implementation of an exercise intervention may be beneficial in both the preoperative and peri- or postoperative period. Further investigation is needed to understand the mechanism through which exercise interventions improve clinical outcomes and which subgroup of patients will gain the most benefit.

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