Two-Week Multimodal Prehabilitation Program Improves Perioperative Functional Capability in Patients Undergoing Thoracoscopic Lobectomy for Lung Cancer: A Randomized Controlled Trial

• Published in: Anesthesia and analgesia Vol. 131; no. 3; pp. 840 - 849
• Main Authors: Liu, Zijia, Qiu, Tian, Pei, Lijian, Zhang, Yuelun, Xu, Li, Cui, Yushang, Liang, Naixin, Li, Shanqing, Chen, Wei, Huang, Yuguang
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01.09.2020
• Subjects: Aged; Beijing; Breathing Exercises; Carcinoma, Non-Small-Cell Lung - surgery; Cardiorespiratory Fitness; Counseling; Dietary Supplements; Exercise Tolerance; Female; Health Status; Home Care Services, Hospital-Based; Humans; Lung Neoplasms - surgery; Male; Middle Aged; Nutritional Status; Pneumonectomy - adverse effects; Pneumonectomy - rehabilitation; Postoperative Complications - prevention & control; Preoperative Care; Recovery of Function; Relaxation Therapy; Resistance Training; Single-Blind Method; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - rehabilitation; Time Factors; Treatment Outcome; Whey Proteins - administration & dosage; Beijing
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0000000000004342

BACKGROUND:Patients with lung cancer often experience reduced functional capacity and quality of life after surgery. The current study investigated the impact of a short-term, home-based, multimodal prehabilitation program on perioperative functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for nonsmall cell lung cancer (NSCLC). METHODS:A randomized controlled trial was conducted with 73 patients. Patients in the prehabilitation group (n = 37) received a 2-week multimodal intervention program before surgery, including aerobic and resistance exercises, respiratory training, nutrition counseling with whey protein supplementation, and psychological guidance. Patients in the control group (n = 36) received the usual clinical care. The assessors were blinded to the patient allocation. The primary outcome was perioperative functional capacity measured as the 6-minute walk distance (6MWD), which was assessed at 1 day before and 30 days after surgery. A linear mixed-effects model was built to analyze the perioperative 6MWD. Other outcomes included lung function, disability and psychometric evaluations, length of stay (LOS), short-term recovery quality, postoperative complications, and mortality. RESULTS:The median duration of prehabilitation was 15 days. The average 6MWD was 60.9 m higher perioperatively in the prehabilitation group compared to the control group (95% confidence interval [CI], 32.4–89.5; P < .001). There were no differences in lung function, disability and psychological assessment, LOS, short-term recovery quality, postoperative complications, and mortality, except for forced vital capacity (FVC; 0.35 L higher in the prehabilitation group, 95% CI, 0.05–0.66; P = .021). CONCLUSIONS:A 2-week, home-based, multimodal prehabilitation program could produce clinically relevant improvements in perioperative functional capacity in patients undergoing VATS lobectomy for lung cancer.