Jejunostomy

In accordance with World Health Organization guidelines, a personalised home-based program was prescribed by an exercise therapist, including a moderate-intensity activity with a minimum duration of 150 min. A tailored exercise programme consisting of aerobic and strength exercises was prescribed based on FITT (frequency, intensity, time and type) principles.
Every week, there was a scheduled telephone touch point with an exercise therapist. When exercise goals were achieved, the exercise programme was progressed according to FITT principles. For those who were unable to meet their goals, the programme was adapted to their clinical condition and re-evaluated at the next touchpoint. Dietetic support was provided by a specialist dietitian who undertook an assessment of nutritional status, including identification and stratification of nutritional risk. A plan was agreed based on symptoms, dietary eating habits and nutritional deficiencies. Weekly or fortnightly phone calls from the dietitian were used to monitor adherence to the programme. Interventions, such as oral supplementation or enteral feeding via a jejunostomy, were established when risk was identified. Psychometric screening was completed for all patients and psychological support was provided by a clinical nurse specialist trained in Level 2 psychological interventions.
The overall aim was to explore and address anxieties or concerns the patient may have regarding their diagnosis, symptoms and/or treatment plan, facilitate adaptation to their current psychological health and disease state and improve self-efficacy.
Motivational interviewing techniques were used by all professionals to identify any potential barriers or facilitators to adherence and facilitate positive behaviour change. This was accompanied by a timeline of agreed goals with personalised written and visual information.
The prehabilitation programme started at the point of diagnosis, once a decision to proceed with curative resection had been made, and continued throughout NAC until the time of surgery. All patients at centre A who underwent surgical resection with curative intent were eligible to participate in the prehabilitation program.
Centre B did not provide prehabilitation. There were no other significant differences in pre-operative care, other than the provision of prehabilitation. Dietetic support in centre B is consistent with national guidelines and consists of an initial assessment and identification of risk followed by further interactions only if there is any deterioration in status.
In both centres, the same chemotherapy and chemo-radiotherapy regimes were used. Patients who required chemotherapy received either 3 cycles each of Epirubicin, Cisplatin and Capecitabine (ECX) or Epirubicin, Oxaliplatin and Capecitabine (EOX) or 4 cycles of Fluorouracil, Leucovorin, Oxaliplatin and Docetaxel (FLOT). Oncologists in both centres attend the weekly specialist multi-disciplinary meeting and work to similar protocols in terms of choice of chemotherapy regimen and clinical behaviours, such as tailoring of the regimen to each individual patient, dose reduction, treatment cessation, etc.

This retrospective cohort study was approved by MacKay Memorial Hospital Institutional Review Board, approval number 21MMHIS178e. Informed consent from participants was not required in this IRB-approved study. Patients with pathologically confirmed, non-metastatic, locally advanced (stage II, III, or IVa) ESCC who completed neoCRT followed by surgery were included. However, patients who died within 3 months of the surgery were excluded from the survival analysis. Cancer staging was performed according to the American Joint Committee on Cancer 8th edition for both clinical and pathological staging. The clinical staging procedures included physical examinations, panendoscopic ultrasound, chest computed tomography (CT), positron emission tomography, and bronchoscopy as needed. Feeding jejunostomy was also deployed to maintain enteric nutrition, although this was not mandatory. After surgery, patients were followed up with chest CT scans every 3–4 months during the first 2 years, and every 6 months during years 3–5. Additional imaging studies were arranged according to clinical necessity. Once the disease recurred, its management was at the discretion of the treating physician and was based on the best patient benefits.