Maarten van Egmond

147 General discussion 7 GENERAL DISCUSSION Physiotherapists play an important role in improving pre-and postoperative physical functioning of patients undergoing elective surgery to enhance recovery and to reduce the risk of postoperative complications and the length of hospital stay. 1 There is increasing evidence that a patient’s preoperative physical functioning is associated with the incidence of postoperative complications and functional recovery. 2-4 Despite the high incidence of postoperative complications in patients with esophageal cancer undergoing esophagectomy, it is currently unknown how preoperative physical functioning relates to the occurrence of postoperative complications and to the recovery of postoperative physical functioning. Therefore, this thesis aimed to investigate the pre-and postoperative course of physical functioning in patients undergoing surgery for esophageal cancer. Main findings Preoperative physical functioning is not associated with postoperative complications in patients with esophageal cancer There is a wealth of evidence describing the association between preoperative physical functioning and postoperative outcome in high-risk surgical populations. 2,4 For example, in patients undergoing coronary artery bypass graft surgery, a strong association was found between preoperative inspiratory muscle strength and postoperative pulmonary complications. 5 Subsequently, the risk of postoperative pulmonary complications significantly decreased by improving patients’ preoperative inspiratory muscle strength. In older patients scheduled for elective abdominal oncological surgery it was shown that preoperatively achieved levels of physical functioning sustained postoperatively. 6 This was further confirmed in a systematic review and meta-analysis of Moran et al. 3 who concluded that improved preoperative physical functioning has the ability to decrease the incidence of postoperative complications. However, we did not find an association between preoperative physical functioning and postoperative complications in patients with esophageal cancer undergoing elective surgery in the Amsterdam University Medical Centers, location Academic Medical Center. We did not find significant differences in preoperative physical functioning, even after comparing the proportion of patients suffering from postoperative complications and those without (Chapter 2) . Although this seemed to be surprising at a first glance, our population differed systematically from comparable high-risk surgical populations in baseline characteristics.