Background: Esophageal cancer and curative treatment have a significant impact on the physical fitness
of patients. Knowledge about the course of physical fitness during neoadjuvant therapy and esophagectomy
is helpful to determine the needs for interventions during and after curative treatment. This
study aims to review the current evidence on the impact of curative treatment on the physical fitness of
patients with esophageal cancer.
Methods: A systematic literature search of PubMed, Embase, Cinahl and the Cochrane Library was
conducted up to March 29, 2021. We included observational studies investigating the change of physical
fitness (including exercise capacity, muscle strength, physical activity and activities of daily living) from
pre-to post-neoadjuvant therapy and/or from pre-to post-esophagectomy. Quality of the studies was
assessed and a meta-analysis was performed using standardized mean differences.
Results: Twenty-seven articles were included. After neoadjuvant therapy, physical fitness decreased
significantly. In the first three months after surgery, physical fitness was also significantly decreased
compared to preoperative values. Subgroup analysis showed a restore in exercise capacity three months
after surgery in patients who followed an exercise program. Six months after surgery, there was limited
evidence that exercise capacity restored to preoperative values.
Conclusion: Curative treatment seems to result in a decrease of physical fitness in patients with
esophageal cancer, up to three months postoperatively. Six months postoperatively, results were conflicting.
In patients who followed a pre- or postoperative exercise program, the postoperative impact of
curative treatment seems to be less.
