Current status of prehabilitation before esophagectomy for patients with esophageal cancer among board-certified hospitals by the Japan Esophageal Society.

Background: Prehabilitation has been shown to prevent postoperative pneumonia and physical function decline after esophagectomy in recent systematic reviews and meta-analyses. However, the implementation status of prehabilitation for esophagectomy remains unknown. This nationwide survey was performed to investigate the current status of and barriers to prehabilitation before esophagectomy among Japanese hospitals.

Methods: This multicenter nationwide survey was performed using the postal mail method. The eligible facilities were 155 Japanese hospitals that had been certified as Authorized Institutes for Board-Certified Esophageal Surgeons by the Japan Esophageal Society within the past 10 years. We administered the original questionnaire to investigate the current status of prehabilitation before esophagectomy, excluding neoadjuvant therapy.

Results: The response rate was 75% (117/155 facilities). The number of facilities providing prehabilitation for esophagectomy was 77 (66%), including prehabilitation in the preoperative outpatient setting in 39 (33%) and in the preoperative inpatient setting in 53 (45%). Among the facilities that did not provide prehabilitation, the most common reasons for not providing prehabilitation (i.e., responses of "agree" and "strongly agree" on questionnaire) were a lack of human resources, preoperative period too short to provide prehabilitation, difficultly using reimbursed medical fees, and no establishment of a standard prehabilitation program.

Conclusions: We elucidated the current implementation status of prehabilitation, identified the critical gap between evidence and practice. This information will contribute to building an effective medical system and framework of prehabilitation for patients with esophageal cancer in Japan and other countries.