Supplementary Material for: Pre- and post-operative Exercise and Nutrition Therapy in Patients with Esophageal Cancer Undergoing Esophagectomy: A Prospective Interventional Study

Introduction: This study aimed to evaluate safety and feasibility of perioperative exercise and nutrition therapy, and to explore changes in skeletal muscle mass (SMM) in patients with esophageal cancer. Methods: Patients scheduled for curative esophagectomy at two hospitals were enrolled. Exercise and nutrition therapy were performed for 3 weeks preoperatively and 4 weeks postoperatively. Outcomes included SMM, which was the sum of both mid-thigh cross-sectional area on computed tomography and physical function, assessed at T1 (intervention start), T2 (just before surgery), and T3 (1-month postoperatively). The SMM change rate between T1 and T3 was compared with the hypothesized value (−7.5%) from our previous study. Results: Thirty-six patients underwent intervention and esophagectomy (intervention completion rate: 94.4%, no serious adverse events). The SMM increased by 4.9% for T1–T2 (p < 0.001) but decreased by 10.1% for T1–T3 (p < 0.001), suggesting that the primary outcome was not achieved. Physical function results were significantly better at T3 than at T1. Postoperative SMM loss was lower in patients who maintained postoperative caloric intake and physical activity than in those who could not (−8.3% vs. −15.4%, p = 0.011). Conclusions: Perioperative exercise and nutrition therapy were safe and feasible. An increase in preoperative SMM and postoperative physical function were observed, although SMM decreased after surgery. Further investigation is warranted to evaluate the efficacy of this intervention.