Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial

• Published in: Interactive cardiovascular and thoracic surgery Vol. 25; no. 3; pp. 476 - 483
• Main Authors: Lai, Yutian, Su, Jianhua, Qiu, Peiyuan, Wang, Mingming, Zhou, Kun, Tang, Yuxin, Che, Guowei
• Format: Journal Article
• Language: English
• Published: England 01.09.2017
• Subjects: Aged; Breathing Exercises - methods; Carcinoma, Non-Small-Cell Lung - rehabilitation; Carcinoma, Non-Small-Cell Lung - surgery; Female; Follow-Up Studies; Forced Expiratory Flow Rates; Humans; Lung Neoplasms - physiopathology; Lung Neoplasms - rehabilitation; Lung Neoplasms - surgery; Male; Middle Aged; Pneumonectomy; Preoperative Care - methods; Treatment Outcome; Postoperative pulmonary complications; Lobectomy; Pulmonary rehabilitation; Lung cancer
• ISSN: 1569-9293; 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivx141

The goal of this study was to assess the impact of a preoperative 1-week, systematic, high-intensity inpatient exercise regimen on patients with lung cancer who had risk factors for postoperative pulmonary complications (PPCs). We conducted a randomized controlled trial with 101 subjects of a preoperative, 7-day systematic, integrated, high-intensity pulmonary exercise regimen. The control group received standard preoperative care. We analysed the occurrence of PPCs in both groups as the primary outcome; other outcomes included changes in blood gas, quality of life, peak expiratory flow rate, the 6-min walk distance and others. The 6-min walk distance showed an increase of 22.9 ± 25.9 m in the intervention group compared with 4.2 ± 9.2 m in the control group, giving a between-group difference of 18.7 m (95% confidence interval: 8.8-28.6; P < 0.001); the peak expiratory flow increased by 25.2 ± 24.6 l/min, compared with 4.2 ± 7.7 l/min (between-group difference: 21.0 m, 95% confidence interval: 7.2-34.8; P = 0.003). The intervention group had a shorter average total (15.6 ± 3.6 vs 17.7 ± 5.3 days, P = 0.023) and postoperative length of stay (6.1 ± 3.0 vs 8.7 ± 4.6 days, P = 0.001) than the control group; the incidence of PPCs (9.8%, 5/51 vs 28.0%, 14/50, P = 0.019) was significantly lower. A multivariable analysis of the risk of PPCs identified short-term rehabilitation intervention to be an independent risk factor (odds ratio = 0.156, 95% confidence interval: 0.037-0.649, P = 0.011). The study results suggested that a systematic, high-intensity pulmonary exercise programme was a practical strategy when performed preoperatively in patients with lung cancer with risk factors for PPCs. ChiCTR-IOR-16008109.