Preoperative Home-based Multimodal Prehabilitation Based on 5G + Artificial Intelligence Mobile Health

The main questions it aims to answer are: Does digital multi-modal prehabilitation reduce the postoperative comprehensive complication index (CCI) compared to conventional care? Does the intervention improve perioperative functional capacity (e.g., 6-minute walk distance, cardiopulmonary function), nutritional status, psychological well-being, chemotherapy adherence, and long-term survival outcomes (3-year overall and disease-free survival)? Researchers will compare the experimental group (receiving at least 2 weeks of 5G+AI digitally supervised home-based multi-modal prehabilitation plus standard ERAS perioperative management) to the control group (receiving conventional management plus standard ERAS perioperative management) in a 1:1 randomization to see if the digital prehabilitation approach significantly lowers postoperative complications, enhances functional reserve, improves nutritional and psychological status, and optimizes recovery and survival.

Inclusion criteria

• Aged 18 years or older
• Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1
• Histologically confirmation of gastric or gastroesophageal junction (GEJ) adenocarcinoma. For GEJ carcinomas, eligibility is strictly confined to those presenting with Siewert type III tumors or Siewert type II tumors that do not mandate a concurrent thoracotomy
• Surgery is planned after neoadjuvant therapy
• Capacity to comprehend and voluntarily sign a written informed consent form
• Ability to use digital technology (e.g., smart phones, wearable devices) independently or with the assistance of family members

Exclusion criteria

• Distant metastasis
• Severe cardiac dysfunction (preoperative LVEF < 30% or NYHA classification IV), severe liver dysfunction (Child-Pugh C grade), severe kidney dysfunction (preoperative CRRT was received), ASA grade IV or above; 6MWD ≤ 250 meters
• Within 6 months before enrollment, the patient had experienced cerebral hemorrhage, cerebral infarction, TIA, or suffered from central nervous system diseases or mental disorders, and was unable to cooperate in completing neoadjuvant therapy and prehabilitation
• Presence of severe systemic infections (e.g., multiple organ dysfunction syndrome [MODS]) or active infectious diseases (e.g., tuberculosis)
• Emergency surgery is required due to complications of the tumor (e.g. bleeding, perforation, obstruction)
• Simultaneous tumors or other diseases requiring simultaneous surgery (excluding laparoscopic cholecystectomy)
• Patients who are participating in any other clinical trials (except observational, non-interventional clinical study)