Exercise Training During Neoadjuvant Treatment for Gastroesophageal Cancer and Tumor Surgery: A Randomized Clinical Trial
In brief
Preoperative exercise did not increase curative surgery rates in gastroesophageal cancer
In this randomized trial of 202 patients, 9.9% assigned to twice-weekly exercise and 7.9% receiving usual care did not undergo surgery with curative intent after neoadjuvant treatment. Treatment discontinuation and postoperative complications also did not differ; 3-year survival was lower in the exercise group, a finding that needs further study.
- Journal
- JAMA network open (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Casper Simonsen, Pieter de Heer, Simon Nørskov Thomsen, Rikke Krabek, Sarah Thorsen-Streit, Mark Preben Printz Lyngbæk, et al.
- PMID
- 42949746
- DOI
- 10.1001/jamanetworkopen.2026.40136
Why clinicians should know about it
- Picked for Surgery (paper of the day, 30 October 2026): Randomized trial of prehabilitation before gastroesophageal cancer surgery
Abstract
IMPORTANCE: Physical deterioration and disease progression during neoadjuvant treatment can preclude tumor surgery in patients with gastroesophageal cancer. Whether preoperative exercise training can increase the probability of undergoing tumor surgery remains unknown. OBJECTIVE: To compare exercise training with usual care on the likelihood of not undergoing tumor surgery with curative intent after neoadjuvant treatment for gastroesophageal cancer. DESIGN, SETTING, AND PARTICIPANTS: PRESET-RCT was a single-blinded, parallel-group, 2-arm, superiority randomized clinical trial. Patients with gastroesophageal adenocarcinoma scheduled to undergo treatment with curative intent, including neoadjuvant treatment, and with no contraindication to exercise training were eligible. Participants were enrolled at University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark, from August 16, 2018, to September 23, 2022, with final follow-up on October 22, 2024. Data analysis was performed from March 2023 to May 2025. INTERVENTION: The participants were randomized 1:1 to preoperative exercise training from diagnosis until tumor surgery or control. The intervention consisted of twice-weekly concurrent aerobic exercise and resistance training. MAIN OUTCOMES AND MEASURES: The primary outcome was not undergoing tumor surgery with curative intent. The secondary outcomes were treatment tolerance and overall survival. RESULTS: In total, 207 participants (73.7%) were randomized and 202 were included in the modified intention-to-treat analyses (mean [SD] age, 65.3 [8.5] years; 161 [78.9%] male; 170 [83.3%] with gastroesophageal junction cancer), with 101 randomized to each group. In the exercise group, 10 (9.9%) did not undergo tumor surgery with curative intent compared with 8 (7.9%) in the control group (odds ratio, 1.28; 95% CI, 0.48-3.38; P = .62). There were no between-group differences in permanent discontinuation of neoadjuvant treatment (odds ratio, 0.81; 95% CI, 0.38-1.72) or postoperative complications (odds ratio, 1.16; 95% CI, 0.61-2.20). The overall survival rates at 3 years for the exercise and control group were 51.0% and 65.0%, respectively (hazard ratio, 1.58; 95% CI, 1.02-2.45). CONCLUSION AND RELEVANCE: In this randomized clinical trial, preoperative exercise training did not increase the likelihood of undergoing tumor surgery for patients with gastroesophageal cancer. The findings do not support the use of exercise training during neoadjuvant treatment to improve surgical outcomes, and further research is needed to determine its effects on long-term outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03490565.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.