Effectiveness of postoperative rehabilitation after discharge in survivors of esophageal or gastroesophageal junction cancers: a systematic review.

Esophageal cancer surgery is highly invasive, often resulting in prolonged declines in health-related quality of life (HRQOL) and physical function. This review aims to evaluate the effectiveness and feasibility of postoperative rehabilitation after discharge for survivors of esophageal and gastroesophageal junction cancers. A systematic search of six databases (CENTRAL, MEDLINE, CINAHL, Web of Science, Scopus, and PEDro) identified eligible studies. Meta-analyses assessed the effects of postoperative rehabilitation after discharge on HRQOL, exercise capacity, muscle strength, skeletal muscle mass, physical activity, physical symptoms. Feasibility was evaluated based on adherence rates, dropout rates, and adverse events. From 9801 records, 12 studies involving 717 participants were included. A meta-analysis of four randomized controlled trials (RCTs) showed significant improvements in HRQOL (SMD [95% CI]: 0.36 [0.08, 0.65]). Another meta-analysis of three RCTs demonstrated improved exercise capacity (SMD [95% CI]: 1.49 [0.32, 2.66]). No statistically significant effects were observed for muscle strength, skeletal muscle mass, physical activity, and physical symptoms. Adherence rates ranged from 69-94% for supervised programs and 74-100% for home-based programs. Dropout rates were 0-25% for supervised programs and 0-23% for home-based programs. No adverse events were reported. Postoperative rehabilitation after discharge improves HRQOL and exercise capacity and is safe for survivors of esophageal or gastroesophageal junction cancers. However, limited evidence due to small sample sizes, high risk of bias, and protocol heterogeneity underscores the need for high-quality studies with larger cohorts to determine optimal strategies.