Seray HAZER, Seher SATAR, İpek CANDEMİR, Pınar ERGÜN, Leyla Nesrin ACAR, Selim Şakir Erkmen GULHAN

Preoperative pulmonary rehabilitation in medical inoperable patients with early stage non-small cell lung cancer and postoperative results

Aims: The impact of postoperative complications after surgery for lung cancer is substantial, with the increasing age of patients and the presence of comorbidities. Impairment in exercise capacity is a potential modifiable risk factor for postoperative complications. This study aimed to assess the contribution of preoperative pulmonary rehabilitation (PR) for increasing operability conditions in non-small cell lung cancer (NSCLC) for patients with limited pulmonary functions and postoperative results. Methods: The patients with NSCLC who had preoperative pulmonary rehabilitation and underwent surgical resection in our clinics between 2010-2019 were evaluated retrospectively. The patients enrolled in a comprehensive, multidisciplinary, supervised outpatient 10-day duration PR program preoperatively, consisting of bronchial hygiene, breathing control, energy conservation techniques, exercise training (endurance and strength), psychological support, and nutritional support. Exercise capacity and VO2 peak were evaluated by using an incremental shuttle walk test (ISWT). Results: Eighteen patients who underwent surgery due to NSCLC and had a pre-operative pulmonary rehabilitation program were evaluated. All the cases were male; the mean age was 66.2 (53-77) years. The squamous cell/adenocarcinoma ratio was 2.6 (13:5), and the mean tumor size was 4.6 (8-18) cm. The postoperative hospital stay was 12.7 (4-42) days, and they were followed up for an average of 30.2 (2-83) months. Conclusion: Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD, increasing their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention for risk modification and to decrease surgical morbidity and mortality. The results of our study also revealed the importance of preoperative pulmonary rehabilitation in centers where lung cancer surgery was performed.

Keywords:

Non-small cell lung cancer, surgery, preoperative pulmonary rehabilitation,

PDF

___

Lee S, Roknuggaman M, Son JA, et al. Prognostic impact of postoperative complications in high-risk operable non-small cell lung cancer. J Chest Surg. 2022;55(1):20-29.
Ferreira V, Minnella EM, Awasthi R, et al. Multimodal prehabilitation for lung cancer surgery: a randomized controlled trial. Ann Thorac Surg. 2021;112(5):1600-1608.
Benzo R, Wigle D, Novotny P, et al. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Lung Cancer. 2011;74(3):441-445.
Licker M, Karenovics W, Diaper J. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. J Thorac Oncol. 2017;12(2):323-333.
Licker M, Schnyder JM, Frey JG, et al. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery. Eur Respir J. 2011;37(5):1189-1198.
Lababede O, Meziane MA. The eighth edition of TNM staging of lung cancer: reference chart and diagrams. Oncologist. 2018;23(7):844-848.
Kaymaz D, Ergün P, Candemir I, Gülhan SE, Fındık G, Demir N. Efficacy of preoperative comprehensive pulmonary rehabilitation in patients with lung cancer. Phys Med Rehabil Int. 2016;3(6):1103-1115.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7-30.
Sherwood JT, Brock MV. Lung cancer: new surgical approaches. Respirology. 2007;12:326-332.
Licker M, Karenovics W, Diaper J. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. J Thorac Oncol. 2017;12(2):323-333.
Cavalheri V.Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev. Coc. 2017;6(6):CD012020.
Nagarajan K, Bennett A, Agostini P, Naidu B. Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? Interact Cardiovasc Thorac Surg. 2011;13(3):300-302.
Varela G, Ballesteros E, Jiménez MF, Novoa N, Aranda JL. Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. Eur J Cardio-thorac Surg. 2006; 29(2):216-220.
Li X, Li S, Yan, S. Impact of preoperative exercise therapy on surgical outcomes in lung cancer patients with or without COPD: a systematic review and meta-analysis. Cancer Manag Res. 2019;11:1765-1777.
Bibo L, Goldblatt J, Merry C. Does preoperative pulmonary rehabilitation/physiotherapy improve patient outcomes following lung resection? Interact Cardiovasc Thorac Surg. 2021;32(6):933-937.
Lai Y, Wang X, Zhou K, Su J, Che G. Impact of one-week preoperative physical training on clinical outcomes of surgical lung cancer patients with limited lung function: a randomized trial. Ann Transl Med. 2019;7(20):544-544.
Laurent H, Aubreton S, Galvaing G, et al. Preoperative respiratory muscle endurance training improves ventilatory capacity and prevents pulmonary postoperative complications after lung surgery. Eur J Phys Rehabil Med. 2020;56(1):73-81.
Fernando HC, Timmerman R. American College of Surgeons Oncology Group Z4099/Radiation Therapy Oncology Group 1021: a randomized study of sublobar resection compared with stereotactic body radiotherapy for high-risk stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2012;144(3):S35-S38.
Pouwels S, Fiddelaers J, Teijink JA, Woorst JF, Siebenga J, Smeenk FW. Preoperative exercise therapy in lung surgery patients: A systematic review. Respir Med. 2015;109(12):1495-1504.
Hulzebos EH, Smit Y, Helders PP, Meeteren NL. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev. 2012;11(11):CD010118.
McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;23;2015(2):CD003793.