Hand-assisted sputum excretion can effectively reduce postoperative pulmonary complications of esophageal cancer

Wang, Wei; Liu, Qi; Yu, Yonghao; Hollywood, MA; Xu, Lei; Zhang, Ruixiang; Sun, Haibo; Wang, Zongfei; Zheng, Yan; Chen, Pei-Nan; Liu, Shilei; Yang, Funa; Zou, Qiyun; Sun, Aiying; Chu, Xiaofei; Gong, Chenfang; Xing, Wei

doi:10.21037/apm-20-1267

Cited by 9 publications

(5 citation statements)

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“…2,[46][47][48][49][50][51][52][53] For the studies assessing periand postoperative physiotherapy, there were six RCTs [54][55][56][57][58][59] comparing an intervention with a control group, and one study 60 compared two different types of physiotherapy. Among the cohort studies, eight studies [61][62][63][64][65][66][67][68] S5. Finally, six RCTs 38,[40][41][42][43][44] and eight cohort studies 2,46-49,51-53 assessing prehabilitation, and five RCTs [54][55][56]58,59 and five cohort studies 61,62,65,67,68 S6 for each analysis.…”

Section: Literature Search Resultsmentioning

confidence: 99%

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Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis

et al. 2021

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Background Esophageal and gastric cancer surgery are associated with considerable morbidity, specifically postoperative pulmonary complications (PPCs), potentially accentuated by underlying challenges with malnutrition and cachexia affecting respiratory muscle mass. Physiotherapy regimens aim to increase the respiratory muscle strength and may prevent postoperative morbidity. Objective The aim of this study was to assess the impact of physiotherapy regimens in patients treated with esophagectomy or gastrectomy. Methods An electronic database search was performed in the MEDLINE, EMBASE, CENTRAL, CINAHL and Pedro databases. A meta-analysis was performed to assess the impact of physiotherapy on the functional capacity, incidence of PPCs and postoperative morbidity, in-hospital mortality rate, length of hospital stay (LOS) and health-related quality of life (HRQoL). Results Seven randomized controlled trials (RCTs) and seven cohort studies assessing prehabilitation totaling 960 patients, and five RCTs and five cohort studies assessing peri- or postoperative physiotherapy with 703 total patients, were included. Prehabilitation resulted in a lower incidence of postoperative pneumonia and morbidity (Clavien–Dindo score ≥ II). No difference was observed in functional exercise capacity and in-hospital mortality following prehabilitation. Meanwhile, peri- or postoperative rehabilitation resulted in a lower incidence of pneumonia, shorter LOS, and better HRQoL scores for dyspnea and physical functioning, while no differences were found for the QoL summary score, global health status, fatigue, and pain scores. Conclusion This meta-analysis suggests that implementing an exercise intervention may be beneficial in both the preoperative and peri- or postoperative periods. Further investigation is needed to understand the mechanism through which exercise interventions improve clinical outcomes and which patient subgroup will gain the maximal benefit.

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Section: Literature Search Resultsmentioning

confidence: 99%

“…Among the cohort studies, eight studies [61][62][63][64][65][66][67][68] S5. Finally, six RCTs 38,[40][41][42][43][44] and eight cohort studies 2,46-49,51-53 assessing prehabilitation, and five RCTs [54][55][56]58,59 and five cohort studies 61,62,65,67,68 S6 for each analysis.…”

Section: Literature Search Resultsmentioning

confidence: 99%

Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis

et al. 2021

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“…Postoperative pain management plays a vital role in ERAS for esophageal cancer. Reducing postoperative pain in patients could enhance postoperative pulmonary rehabilitation, such as coughing and expectoration, and concurrently lower the incidence of pulmonary complications [14][15][16][17] . Our results exposed that the pain score of patients undergoing SSP SILS + 1 was signi cantly lower than that of patients undergoing CLS on POD1, possibly attributed to the smaller number and length of incisions.…”

Section: Discussionmentioning

confidence: 99%

Advantages of the Split-leg Supine position Single-port plus one laparoscopic Surgery Approach

Xin,

Yongkui,

Zimin

et al. 2024

Preprint

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Background: The goal of this study was to compare the advantages of CLS and SSP SILS+1 in esophageal surgery. Methods: This study enrolled 73 patients who previously underwent radical esophagectomy for esophageal cancer from August 2021 to February 2023. Among them, 36 patients underwent SSP SILS+1, whereas the remaining 37 patients underwent conventional laparoscopic surgery (CLS). Surgical time, bleeding volume, number of dissected lymph nodes, incision length, and postoperative abdominal pain score between the two groups of patients were compared using either the Student's t-test or chi-square test. Results: Time of abdominal incision (1.4±0.2 min vs. 5.2±0.7 min，p<0.001) and bleeding volume (7.0±3.0 mL vs. 8.0±4.0mL，p<0.001) were significantly lower in patients in the SSP SILS+1 group compared with those in the CLS group. However, the average incision length was shorter in the SSP SILS+1 group compared with that in the CLS group (35.4±4.0 cm vs 4.6±4.1 cm, p<0.001). Notably, the pain score on postoperative day (POD) 1 was significantly lower in the SSP SILS+1 group compared with that in the CLS group (5.7±0.7 vs.6.3±0.7，p=0.001). The SCAR score was alsovsignificantly lower in the SSP SILS+1 group compared with that in the CLS group (3.5±0.9 vs 8.3±1.4, p=0.019). There was no significant difference in the number of dissected abdominal lymph nodes and positive lymph nodes (p>0.01) between the two groups. Conclusion: The SSP SILS+1 intervention offers multiple benefits over conventional surgical procedures, encompassing shorter incision length and pain scores on POD 1. In accelerated rehabilitation surgery for esophageal cancer, this surgical procedure demonstrated high safety, feasibility.

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“…Preoperative assessment of IMW may help identify patients who are at a higher risk for PPCs and should be managed more cautiously, for example, with frequent physiotherapy 24 . Also, a postoperative approach to assist sputum clearance has been reported to reduce PPCs, and there is considerable evidence that continuous preoperative and postoperative management is important for the prevention of PPCs 25,26 …”

Section: Discussionmentioning

confidence: 99%

“…24 Also, a postoperative approach to assist sputum clearance has been reported to reduce PPCs, and there is considerable evidence that continuous preoperative and postoperative management is important for the prevention of PPCs. 25,26 Age, smoking status, nutritional status, respiratory disease, and sarcopenia are reported risk factors for PPCs after esophagectomy. [3][4][5][6][7]27 Moreover, each of these factors has also been reported to be associated with inspiratory muscle strength.…”

Section: Discussionmentioning

confidence: 99%

Preoperative inspiratory muscle weakness as a risk factor of postoperative pulmonary complications in patients with esophageal cancer

Okura,

Suto,

Sato

et al. 2023

Journal of Surgical Oncology

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ObjectiveWe examined whether preoperative inspiratory muscle weakness (IMW) is a risk factor for postoperative pulmonary complications (PPCs) in patients with esophageal cancer who underwent subtotal esophagectomy.MethodsThis single‐center retrospective cohort study enrolled patients with esophageal cancer who underwent a scheduled subtotal esophagectomy between June 2020 and May 2022. Maximal inspiratory pressure (MIP) was measured as inspiratory muscle strength using a respiratory dynamometer, and we defined IMW as MIP < 80% of the predicted value. Our primary outcome comprised overall PPCs. We investigated the relationship between IMW and PPCs using the Bayesian logistic regression model.ResultsAfter exclusion, 72 patients were included in this study. IMW was identified in 26 patients (36%), and PPCs developed in 28 patients (39%). Among patients with IMW, 15 (58%) developed PPCs. Preoperative IMW was associated with PPCs (mean odds ratio [OR]: 3.58; 95% credible interval [95% CrI]: 1.29, 9.73) in the unweighted model. A similar association was observed in the weighted model adjusted for preoperative and intraoperative contributing factors (mean OR: 4.15; 95% CrI: 2.04, 8.45).ConclusionsPreoperative IMW was associated with PPCs in patients with esophageal cancer who underwent subtotal esophagectomy. This association remained after adjusting for preoperative and intraoperative contributing factors.

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Hand-assisted sputum excretion can effectively reduce postoperative pulmonary complications of esophageal cancer

Cited by 9 publications

References 0 publications

Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis

Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis

Advantages of the Split-leg Supine position Single-port plus one laparoscopic Surgery Approach

Preoperative inspiratory muscle weakness as a risk factor of postoperative pulmonary complications in patients with esophageal cancer

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