Multimodal rehabilitation interventions for psychological outcomes in adults after esophageal cancer surgery: A systematic review and meta-analysis.

PURPOSE: Psychological distress is common following esophageal cancer surgery and may adversely affect postoperative recovery and quality of life. This systematic review and meta-analysis evaluated the effects of multimodal rehabilitation on psychological outcomes in adults following esophageal cancer surgery. METHODS: This systematic review and meta-analysis followed PRISMA 2020 and was registered in PROSPERO (CRD420251273089). Eleven electronic databases and two clinical trial registries were searched from inception to January 2026. Randomised controlled trials evaluating multimodal rehabilitation incorporating psychological support were included. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. RESULTS: Twenty-two randomised controlled trials were included, of which 19 contributed to the meta-analysis. Multimodal rehabilitation was associated with lower depression scores (SMD = -1.47, 95% CI -1.72 to -1.23; I2 = 64.4%) and anxiety scores (SMD = -1.52, 95% CI -1.91 to -1.12;I2= 83.3%). SCL-90 total scores were also lower (MD = -1.85, 95% CI -2.02 to -1.71; I2 = 0%). Certainty of evidence was low for all outcomes, and the pooled anxiety effect may have been inflated by small-study effects or publication bias. CONCLUSION: Multimodal rehabilitation may have potential value in supporting psychological recovery after esophageal cancer surgery. However, the magnitude and clinical importance of the effects remain uncertain because of low-certainty evidence, heterogeneity, and possible publication bias. Further high-quality multicentre randomised controlled trials are needed.