A randomized controlled trial on the effect of beetroot juice on VO2max in patients undergoing a minimally invasive esophagectomy

BEET-MIE is a 2-arm RCT investigating the added effect of one consecutive week of beetrootjuice (BRJ) consumption in prehabilitated patients scheduled to undergo a minimally invasive esophagectomy for cancer. Primarily the impact on VO2max. Cardiopulmonary complications, functional recovery, surgical complications and quality of life amongst others are also carefully monitored.

It has been reported that patients with lower VO2max and VO2peak (the peak oxygen uptake during incremental exercise) values, have a significantly higher risk of cardiopulmonary complications (CPC) following an esophagectomy, while consumption of beetroot juice has been shown in multiple studies to improve exercise performance and oxygen metabolism (including VO2max and VO2peak) in both young, healthy individuals as well as the elderly suffering from cardiovascular disease and COPD.

- VO2max and other PREPARE measurements: 1 week preoperatively and at admission on the day before surgery
- Functional recovery: during admission.
- Cardiopulmonary complications: within 30 days after surgery.
- Anastomotic leakage: within 30 days after surgery by clinical/radiological signs or confirmed by reoperation
- All other (surgical) complications: within 30 days after surgery
- Quality of life: baseline, 1 week preoperatively, at admission on the day before surgery, 1 week, 3 weeks, and 6 weeks postoperatively

Nitrate-rich Beet It Sport shot (70cc) versus nitrate-depleted Beet It Sport shot (placebo, 70cc). Depending on randomization patients will be take 1 bottle once daily for seven consecutive days directly before surgery.
The aforementioned PREPARE program is a personalized, home-based prehabilitation program for all esophageal cancer patients scheduled to undergo an elective esophagectomy. Nutritional status, physical capacity and mental wellbeing of patients is optimized in collaboration with and under supervision of a multidisciplinary team from the hospital. The PREPARE program has already been fully implemented since 2018.