Maarten van Egmond

163 Summary S PHYSICAL FUNCTIONING IN SURGICAL PATIENTS WITH ESOPHAGEAL CANCER: from risk stratification to targeted physiotherapy A large proportion of patients with esophageal cancer develops a postoperative complication. Impairments in preoperative physical functioning are an important prognostic factor for the development of postoperative complications and a delayed functional recovery. There is significant evidence for the relationship between preoperative physical functioning and postoperative functional recovery, but this evidence is lacking for patients with esophageal cancer. To determine which patients are at risk for postoperative complications and a delayed functional recovery, the course of pre- and postoperative physical functioning over time has been systematically investigated in this thesis. Based on this, patients can be identified who may benefit from tailor-made pre- or postoperative physiotherapy treatment to enhance postoperative recovery. Chapter 1 explains the consequences of major abdominal and/ or thoracic surgery on physical functioning and what contribution the physical therapist can make in both the pre- and postoperative trajectory. The main objective of this thesis is to evaluate the pre- and postoperative course of physical functioning in patients with esophageal cancer who undergo surgery. In addition, the objectives per study have been described. Chapter 2 describes whether there is a relationship between preoperative functioning and the occurrence of postoperative complications in patients with esophageal cancer who have undergone surgery. A prospective cohort study was conducted for this purpose between March 2012 and October 2014, in which 94 patients with esophageal cancer were examined for determinants of physical functioning one day before the operation. This involved inspiratory muscle strength, handgrip strength, physical activities and quality of life. Postoperative complications were registered according to the Clavien-Dindo classification. Of the 94 patients enrolled in this study, 90 patients underwent esophageal resection with gastric tube reconstruction. Of these, 55 patients developed one or more postoperative complications. After performing univariate and multivariate regression analyzes, there appeared to be no relationship between preoperative physical functioning and the occurrence of postoperative complications. In contrast to other comparable populations undergoing thoracic surgery, preoperative physical functioning in patients with esophageal cancer appears not to be associated with postoperative complications.