Inspiratory muscle training before esophagectomy

Evidence label: Negative randomized clinical-outcome evidence · Clinical goal: prevent pneumonia after esophagectomy

Evidence at a glance

Population: 241 people scheduled for esophagectomy across multiple centers.
Intervention: home-based inspiratory muscle training before surgery, compared with usual care.
Result: breathing strength improved, but postoperative pneumonia did not decrease.

What was studied

The PREPARE trial randomized 120 participants to inspiratory muscle training and 121 to usual care. Pneumonia was the primary outcome; respiratory muscle function, other complications, ventilation, hospital stay and physical function were secondary.

What the evidence shows

Pneumonia occurred in 39.2% of the training group and 35.5% of controls (RR 1.10, 95% CI 0.79 to 1.53; P=.561). Inspiratory strength and endurance improved more with training, but this physiological change did not translate into fewer pneumonias or better postoperative outcomes.

This is a useful negative result: stronger measured breathing muscles are not the same as a proven reduction in clinical complications.

Cancer-control boundary: This trial tested postoperative pneumonia and respiratory function, not tumor response, recurrence, progression or survival. It cannot establish a cancer-control benefit.

Limits and uncertainty

The intervention was home based and adherence or technique may vary. The confidence interval allows both some benefit and some harm, although the point estimate did not favor training. Later smaller trials and reviews report respiratory-function signals, but pooled evidence has not established fewer postoperative complications.

Safety and practical context

Breathing training should be coordinated with the surgical pathway and should not delay staging, nutrition support or surgery. Severe breathlessness, chest pain, fainting, aspiration symptoms or new respiratory infection need medical assessment.

Questions for the care team

Is pneumonia prevention the goal, or is the aim simply to build respiratory capacity?
Who will check technique and adherence before surgery?
What other measures—nutrition, smoking cessation, airway care and early mobilization—are part of my perioperative plan?

Sources

Literature searched: October 22, 2026 · Record appraised: October 22, 2026

Educational evidence summary, not personal medical advice. Research regimens describe what was studied; they are not personal prescribing instructions and should not replace cancer treatment or individualized supportive care.