Structured perioperative rehabilitation reduces postoperative pneumonia in esophageal cancer patients.

BackgroundPulmonary complications remain a major challenge after esophagectomy for esophageal cancer. While rehabilitation interventions aligned with Enhanced Recovery After Surgery (ERAS) principles show promise, the term “rehabilitation” is often applied to highly variable approaches—from isolated breathing exercises to comprehensive multimodal programs—raising concerns about clinical interpretability and generalizability. This systematic review evaluates the effectiveness of structured perioperative rehabilitation, with emphasis on intervention comprehensiveness, timing, and implications for real-world implementation.MethodsWe systematically searched PubMed, CINAHL, Cochrane Library, Web of Science, CNKI, Wanfang, and CBM from inception to October 31, 2024. Of 37 included studies, only 12 delivered interventions integrating ≥2 core components (e.g., exercise plus nutrition or education). Due to high clinical and statistical heterogeneity (I2 > 90% for most outcomes), we prioritized narrative synthesis and conducted meta-analyses only within homogeneous subgroups—particularly those delivering continuous care across both preoperative and postoperative periods. Outcomes included functional capacity (6-min walk distance), cardiopulmonary function, pneumonia incidence, length of hospital stay (LOS), and health-related quality of life (HRQoL).ResultsComprehensive perioperative rehabilitation (integrating prehabilitation and postoperative rehabilitation) was uniquely associated with a significant reduction in postoperative pneumonia [RR = 0.34, 95% CI (0.19, 0.61); p