Physical functioning in surgical patients with esophageal cancer From risk stratification to targeted physiotherapy

A large proportion of patients with esophageal cancer develops a postoperative complication. Impairments in preoperative physical functioning are an important prognostic factor for the development of postoperative complications and a delayed functional recovery. There is significant evidence for the relationship between preoperative physical functioning and postoperative functional recovery, but this evidence is lacking for patients with esophageal cancer. To determine which patients are at risk for postoperative complications and a delayed functional recovery, the course of pre- and postoperative physical functioning over time has been systematically investigated in this thesis.
We described the association of preoperative physical functioning and postoperative complications in patients with esophageal cancer undergoing elective surgery. Moreover, the pre-and postoperative course of physical functioning in patients with esophageal cancer who underwent surgery was investigated.
We also described the relation between preoperative muscle mass and handgrip strength, respiratory muscle strength and functional lower extremity strength in patients with esophageal cancer awaiting surgery, prior to neoadjuvant chemoradiation.
A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the effects of telerehabilitation on postoperative outcomes and quality of life in surgical patients.
Finally, the feasibility of a 12-week postoperative physiotherapy intervention with telerehabilitation was investigated for patients suffering from postoperative complications.
This thesis showed the importance of systematically evaluating pre- and postoperative physical functioning, before determining who is at risk of a delayed postoperative recovery. Based on this, patients can be identified who may benefit from tailor-made pre- or postoperative physiotherapy treatment to enhance postoperative recovery.