[Application of Single-hole Thoracoscopic Surgery Combined with ERAS Concept for Respiratory Function Exercise in Perioperative Period of Lung Cancer].
Shi Qingtong,Diao Yali,Qian Jun
Zhongguo fei ai za zhi = Chinese journal of lung cancer
BACKGROUND:Lung cancer is currently the leading malignant tumor in both domestic and foreign morbidity and mortality. Surgical treatment is the main treatment option for lung cancer. The aim of this study is to explore the effects of enhanced recovery after surgery (ERAS) combined with respiratory function exercise combined with single-hole thoracoscopic surgery on lung cancer patients with postoperative pulmonary complications, postoperative pain, time to get out of bed, time to extubation and length of hospital stay. METHODS:A total of 240 patients who underwent endoscopic lung cancer surgery at the Affiliated Hospital of Yangzhou University and the Yancheng First People's Hospital from October 2017 to October 2019 were randomly divided into 4 groups, with 60 patients in each group. Patients in group A underwent single-hole thoracoscopic surgery, and preoperatively performed ERAS concept education and respiratory function training; group B used conventional 3-hole thoracoscopic surgery, and performed ERAS concept education and respiratory function training before operation; group C used conventional 3-hole thoracoscopic operation surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept education; group D used single-hole thoracoscopic surgery, routine hospitalization education and nursing guidance, routine respiratory function training, no preoperative ERAS concept mission. The number of postoperative pulmonary complications, postoperative pain, time to get out of bed, extubation time, and hospital stay were recorded in the four groups. RESULTS:Compared with the groups B, C, and D, the incidence of pulmonary complications was significantly reduced, and the time to get out of bed, extubation time, and hospital stay were significantly shortened in group A. Compared with groups B, C, the postoperative pain was significantly reduced in group A. Compared with group C, the pulmonary complications were significantly reduced, and the time to get out of bed, extubation time and hospital stay were significantly shortened in group B. The differences were statistically significant (P<0.05). There was no significant difference in postoperative pain between group A and group D, group B and group C (P>0.05). CONCLUSIONS:For patients with single-hole thoracoscopic lung cancer surgery, the ERAS concept guidance can effectively reduce the incidence of pulmonary complications and postoperative pain, shorten the time to get out of bed, the time to extubate, and the length of hospital stay.
10.3779/j.issn.1009-3419.2020.101.26
Short-Term Preoperative High-Intensity Interval Training in Patients Awaiting Lung Cancer Surgery: A Randomized Controlled Trial.
Licker Marc,Karenovics Wolfram,Diaper John,Frésard Isabelle,Triponez Frédéric,Ellenberger Christoph,Schorer Raoul,Kayser Bengt,Bridevaux Pierre-Olivier
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
INTRODUCTION:Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications. METHODS:Patients with operable lung cancer were randomly assigned to usual care (UC) (n = 77) or preoperative rehabilitation based on HIIT (Rehab) (n = 74). Maximal cardiopulmonary exercise testing and the 6-minute walk test were performed twice before surgery. The primary outcome measure was a composite of death and in-hospital postoperative complications. RESULTS:The groups were well balanced in terms of patient characteristics. During the preoperative waiting period (median 25 days), the peak oxygen consumption and the 6-minute walking distance increased (median +15%, interquartile range, 25th to 75 percentile [IQR25%-75%, %] = +9% to +22%, p = 0.003 and +15%, IQR25%-75% = +8% to +28%, p < 0.001, respectively) in the Rehab group, whereas peak oxygen consumption declined in the UC group (median -8%, IQR25%-75% = -16% to 0%], p = 0.005). The primary end point did not differ significantly between the two groups: at least one postoperative complication developed in 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group (p = 0.080). Notably, the incidence of pulmonary complications was lower in the Rehab compared with in the UC group (23% versus 44%, p = 0.018), owing to a significant reduction in atelectasis (12.2% versus 36.4%, p < 0.001), and this decrease was accompanied by a shorter length of stay in the postanesthesia care unit (median -7 hours, IQR25%-75% = -4 to -10). CONCLUSIONS:In this randomized controlled trial, preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.
10.1016/j.jtho.2016.09.125
Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta-analysis.
Wang Ya-Qing,Liu Xin,Jia Yong,Xie Jiao
Journal of clinical nursing
AIMS AND OBJECTIVES:To assess the effects of breathing exercises on postoperative pulmonary complications (PPCs), pulmonary function, 6-min walk distance (6MWD) and the length of hospital stay (LOS) in lung cancer patients undergoing lung surgery. BACKGROUND:Lung cancer patients undergoing lung resection have poor pulmonary function and multiple PPCs. Breathing exercises may improve these symptoms. DESIGN:Systematic literature review and meta-analysis were conducted. METHODS:All entries to the following databases were searched up until 20 December 2017: PubMed, EMBASE Ovid, the Cochrane Central Register of Randomized Controlled Trials, Web of Science, Wanfang, Weipu and Chinese National Knowledge Infrastructure databases. Only randomised controlled trials (RCTs) were included in the analysis. RESULTS:A total of sixteen articles including nine articles in Chinese language and seven articles in English met the inclusion criteria. Breathing exercises decreased PPCs, and in addition, the incidence of pneumonia and atelectasis in the postoperative subgroup was reduced. Predicted forced expiratory volume in 1 s (predicted FEV %), predicted forced vital capacity (predicted FVC%), FVC and FEV /FVC ratio had improved after breathing exercises, but the changes in FEV were not statistically significant. Furthermore, the LOS was significantly decreased, but no improvements were found in 6MWD. CONCLUSIONS:The results showed that breathing exercises could improve lung function, decrease the incidence of PPCs and LOS in a sample of lung cancer patients undergoing pulmonary surgery. RELEVANCE TO CLINICAL PRACTICE:The analysis suggests that breathing exercises should be considered as a respiratory rehabilitation programme for lung cancer patients undergoing lung surgery in clinical practice.
10.1111/jocn.14696
In-Hospital Physiotherapy and Physical Recovery 3 Months After Lung Cancer Surgery: A Randomized Controlled Trial.
Jonsson Marcus,Ahlsson Anders,Hurtig-Wennlöf Anita,Vidlund Mårten,Cao Yang,Westerdahl Elisabeth
Integrative cancer therapies
. Lung cancer is the most frequently diagnosed cancer and one of the leading causes of cancer deaths. Surgery is the primary approach for curative treatment. Postoperative complications are common, and physiotherapy is often routinely provided for their prevention and treatment, even though the evidence is limited. The aim of this study was to examine the effect of in-hospital physiotherapy on postoperative physical capacity, physical activity, and lung function among patients undergoing lung cancer surgery. . A total of 107 patients undergoing elective thoracic surgery were included in a single-blinded randomized controlled trial, and randomized to a study group, receiving in-hospital physiotherapy treatment, or a control group, not receiving in-hospital physiotherapy treatment. The patients were assessed preoperatively and 3 months after surgery. The in-hospital physiotherapy treatment consisted of early mobilization, ambulation, breathing exercises, and thoracic range of motion exercises. Physical capacity was assessed with the 6-minute walk test. Level of physical activity was objectively assessed with an accelerometer and subjectively assessed with the International Physical Activity Questionnaire Modified for the Elderly. . Physical capacity for the whole sample was significantly decreased 3 months postoperatively compared with preoperative values ( = .047). There were no statistically significant differences between the groups regarding physical capacity, physical activity, spirometric values, or dyspnea. However, patients in the study group increased their level of self-reported physical activity from preoperatively to 3 months postoperatively, while the patients in the control group did not. . No difference in physical capacity, physical activity, or lung function was found 3 months postoperatively in lung cancer surgery patients receiving in-hospital physiotherapy compared with control patients.
10.1177/1534735419876346
Preoperative respiratory muscle endurance training improves ventilatory capacity and prevents pulmonary postoperative complications after lung surgery.
Laurent Hélène,Aubreton Sylvie,Galvaing Géraud,Pereira Bruno,Merle Patrick,Richard Ruddy,Costes Frédéric,Filaire Marc
European journal of physical and rehabilitation medicine
BACKGROUND:Resection surgery is the main treatment for non-small cell lung cancer (NSCLC). Postoperative complications and mortality are mostly linked to respiratory failure consecutive to respiratory muscle overload. AIM:We aimed to evaluate the effect of preoperative respiratory muscle endurance training (RMET) on respiratory muscle capacity and postoperative complications in patients undergoing NSCLC resection. DESIGN:Randomized controlled trial. SETTING:French university hospital. POPULATION:Patients eligible for NSCLC resection. METHODS:The training group (T group) performed a 3-week preoperative RMET added to usual chest physical therapy while the control group (C group) had only the latter. The primary outcome was the change in respiratory muscle endurance. Secondary outcomes were postoperative complications and mortality. Assessments were performed similarly at baseline and after the intervention. We conducted multivariable analyses with analysis of covariance (ANCOVA) taking into account baseline values for isocapnic hyperpnoea endurance test, exercise capacity and pulmonary function tests. The number of pulmonary postoperative complication was analyzed by Fisher-exact test. RESULTS:We included 26 patients with NSCLC (14 in the T group and 12 in the C group). Respiratory muscle endurance significantly increased in the T group after the RMET compared with C group (+229±199 vs. -5±371 sec, P=0.001). This increase was associated with a significantly lower number of pulmonary postoperative complications (2 vs. 10, P=0.037). CONCLUSIONS:Preoperative RMET improved respiratory muscle endurance and decreased pulmonary postoperative complications after surgery for NSCLC. These positive results obtained after RMET may help improve the perioperative course for such patients. These results should be confirmed in larger randomized controlled trials, including higher number of patients especially with altered respiratory muscle function. CLINICAL REHABILITATION IMPACT:Low-cost and easy to perform, RMET training could serve as complementary tool to usual chest physical therapy, before lung resection surgery.
10.23736/S1973-9087.19.05781-2
Early initiated postoperative rehabilitation reduces fatigue in patients with operable lung cancer: A randomized trial.
Quist Morten,Sommer Maja Schick,Vibe-Petersen Jette,Stærkind Maja Bohlbro,Langer Seppo W,Larsen Klaus Richter,Trier Karen,Christensen Merete,Clementsen Paul F,Missel Malene,Henriksen Carsten,Christensen Karl Bang,Lillelund Christian,Langberg Henning,Pedersen Jesper H
Lung cancer (Amsterdam, Netherlands)
INTRODUCTION:Little is known about the optimal amount and timing of exercise strain in concern of the operation wound and with regard improvement of physical function and quality of life (QOL) after surgery for lung cancer. On this background, we decided to investigate the effect of early vs. late initiated postoperative rehabilitation in patients with operable lung cancer on exercise capacity, functional capacity, muscle strength, and QOL. METHODS:The study was designed as a two-armed randomized controlled trial with randomization to either early initiated postoperative rehabilitation (14 days after surgery (ERG)) or a control arm with late initiated postoperative rehabilitation (14 weeks after surgery (LRG)). The primary endpoint was a change in maximum oxygen consumption (VO2peak) from baseline to post intervention 26 weeks following lung resection. Fatigue was measured with EORTC QLQ C30 LC13. RESULTS:From April 2013 to June 2016, 582 patients with operable NSCLC were screened for eligibility. With 119 patients randomized in the early rehabilitation group (ERG) and 116 randomized to late rehabilitation group (LRG). There was no significant difference from baseline to 26 weeks between ERG and LRG (p = 0.926). There was a significant difference from baseline to 14 weeks between groups (p = 0.0018). There was a significant difference from 14 weeks to 26 weeks between the two groups (p < 0.001). We found no significant differences in QOL but we found a significant difference between ERG and LRG from baseline to 14 weeks in fatigue level in favour of ERG. CONCLUSION:This is the first randomized controlled trial to investigate the effects of early vs. late initiated postoperative rehabilitation in patients with lung cancer. There is no difference in the commencement (early vs. late) of a postoperative exercise program for patients with lung cancer on exercise capacity. But to reduce fatigue patients should be recommended to initiate early exercise programs.
10.1016/j.lungcan.2018.10.025