Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study

Boujibar, Fairuz; Bonnevie, Tristan; Debeaumont, David; Bubenheim, Michael; Cuvellier, Antoine; Peillon, Christophe; Gravier, Francis‐Edouard; Baste, Jean-Marc

doi:10.21037/jtd.2018.03.161

Cited by 55 publications

(37 citation statements)

References 38 publications

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“…Patients with poor pulmonary function had better short-term surgical outcomes after undergoing preoperative HIIT. 52 Standard-risk patients did not see similar reductions in perioperative morbidity following HIIT in one study, but HIIT helped to prevent decline after surgery in all patients in another study. 53,54 Similarly, enhanced recovery after surgery protocols (ERASP) are revolutionizing perioperative thoracic surgery care.…”

Section: Enhancing Surgical Outcomesmentioning

confidence: 93%

Early-Stage NSCLC: Advances in Thoracic Oncology 2018

Osarogiagbon¹,

Veronesi

Fang

et al. 2019

Journal of Thoracic Oncology

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2018 was a banner year for all thoracic oncology, but especially for early-stage NSCLC. Three seminal events occurred in the approximately 18 months from mid-2017 to the end of 2018: in June 2017 at the American Society of Clinical Oncology Annual Meeting a small, relatively unheralded study from Max Diehn's group at Stanford University reported on the use of a novel "cancer personalized profiling by deep sequencing" circulating tumor-DNA technology to identify minimal residual disease in patients after curative-intent radiation or surgery for NSCLC; in April 2018 at the American Association for Cancer Research Annual Meeting, Drew Pardoll presented a small pilot study of 21 patients who had received two doses of preoperative nivolumab; in September 2018, at the 19th World Conference on Lung Cancer, Harry J. De Koning presented the long-awaited results of the Dutch-Belgian Lung Cancer Screening Trial (NELSON). These three seminal studies, along with others which are reviewed in this paper, promise to accelerate our progress towards a world in which lung cancer is identified early, more patients undergo curative-intent treatment that achieves the promised cure, and those at risk for failure after treatment are identified early, when the cancer remains most vulnerable. The day is around the corner when lung cancer is defanged and no longer the worldwide terror it currently is. We herein present an overview of the most recent body of work that moves us inexorably towards that day.

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Section: Enhancing Surgical Outcomesmentioning

confidence: 93%

Early-Stage NSCLC: Advances in Thoracic Oncology 2018

Osarogiagbon¹,

Veronesi

Fang

et al. 2019

Journal of Thoracic Oncology

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“…For patients with chronic pulmonary disorders, this would include the utilization of preoperative lung expansion exercises. In some series, this approach has reduced the risk of pulmonary morbidity, particularly after abdominal and thoracic procedures . Effective pulmonary prehabilitation could have a dramatic impact in the head and neck surgical population and should be a focus of future research efforts.…”

Section: Preoperative Pulmonary Assessment and Interventionmentioning

confidence: 99%

The evidence‐based preoperative assessment for the otolaryngologist

et al. 2019

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There is a narrow window of opportunity between surgical scheduling and the operative date to optimize patients for an elective surgical procedure. Traditionally, preoperative care has involved extended routine testing batteries with intermittent referrals for medical clearance. These traditions are costly, inefficient, and yield no clear reduction in perioperative morbidity and mortality. Evidence, which has evolved over the past decade, suggests that optimal preoperative care requires a patient-centric, personalized, and often multidisciplinary approach. We present an up-to-date overview of this literature with a focus on the otolaryngologic surgical population. An algorithmic approach to preoperative patient assessment is also proposed in hopes of both optimizing patient outcome and streamlining routine clinical workflow.

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“…Boujibar et al (33) reported their results in a recent study with the objective to determine whether participation in a prehabilitation program would improve outcomes after surgery and lower morbidity according to the Clavien-Dindo classification. The cohort included 38 patients with potentially resectable lung cancer and VO 2 max ≤20 mL/min/kg.…”

Section: Who Could Benefit From a Prehabilitation?mentioning

confidence: 99%

Prehabilitation in thoracic surgery

Sánchez-Lorente¹,

Navarro-Ripoll²,

Guzmán³

et al. 2018

J. Thorac. Dis.

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Surgical resection remains the best treatment option for patients with early stage of non-small cell lung cancer (NSCLC). However, it may be responsible of postoperative complication and mortality, especially in patients with impaired pulmonary function. Enhanced recovery after surgery (ERAS) programs have been focused mainly in minimal invasive surgery approach during lung resection and respiratory rehabilitation after surgery. Preoperative exercise-based intervention (prehabilitation) has demonstrated reduction of morbi-mortality in other surgeries but in thoracic surgery continues to be under discussion. Cardio-pulmonary exercise test (CPET) is the gold standard technique to predict postoperative morbimortality. The implementation of a preoperative respiratory rehabilitation could optimize patient's physical capacity before surgery and improve outcomes and enhance recovery. The aim of this systematic review of the literature is to identify the effectiveness and safety of prehabilitation programs in thoracic surgery, the type of exercise and its duration, and the group of patients with best benefit. Prehabilitation is a safe intervention without side effects in patients. High-intensity interval training (HIT) with duration of 2 to 6 weeks seems to be the best exercise programme in a prehabilitation intervention but it exists heterogeneity in terms of intensity and duration. Prehabilitation increase exercise capacity and significantly enhances pulmonary function. But the reduction of postoperative complication and mortality has not been clearly demonstrated. Different criteria selection, type of intervention and small sample size, in addition to no randomization, could justify disparate results. It seems that not all patients can benefit from prehabilitation and it could be indicated only in patients with impaired lung function. Further randomized clinical trials with enough patients, correct duration of HIT (2 to 6 weeks) and focused in COPD patients are needed to clarify the suitability of prehabilitation. Meanwhile, safety of prehabilitation and good results of some studies support this intervention in high-risk patients.

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Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study

Cited by 55 publications

References 38 publications

Early-Stage NSCLC: Advances in Thoracic Oncology 2018

Early-Stage NSCLC: Advances in Thoracic Oncology 2018

The evidence‐based preoperative assessment for the otolaryngologist

Prehabilitation in thoracic surgery

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