Multidisciplinary Team-Based Approach for Comprehensive Preoperative Pulmonary Rehabilitation Including Intensive Nutritional Support for Lung Cancer Patients

Abstract

BackgroundTo decrease the risk of postoperative complication, improving general and pulmonary conditioning preoperatively should be considered essential for patients scheduled to undergo lung surgery.ObjectiveThe aim of this study is to develop a short-term beneficial program of preoperative pulmonary rehabilitation for lung cancer patients.MethodsFrom June 2009, comprehensive preoperative pulmonary rehabilitation (CHPR) including intensive nutritional support was performed prospectively using a multidisciplinary team-based approach. Postoperative complication rate and the transitions of pulmonary function in CHPR were compared with historical data of conventional preoperative pulmonary rehabilitation (CVPR) conducted since June 2006. The study population was limited to patients who underwent standard lobectomy.ResultsPostoperative complication rate in the CVPR (n = 29) and CHPR (n = 21) were 48.3% and 28.6% (p = 0.2428), respectively. Those in patients with Charlson Comorbidity Index scores ≥2 were 68.8% (n = 16) and 27.3% (n = 11), respectively (p = 0.0341) and those in patients with preoperative risk score in Estimation of Physiologic Ability and Surgical Stress scores >0.3 were 57.9% (n = 19) and 21.4% (n = 14), respectively (p = 0.0362). Vital capacities of pre- and post intervention before surgery in the CHPR group were 2.63±0.65 L and 2.75±0.63 L (p = 0.0043), respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6815). Forced expiratory volumes in one second of pre- and post intervention before surgery in the CHPR group were 1.73±0.46 L and 1.87±0.46 L (p = 0.0012), respectively; however, their transition in the CVPR group was not statistically significant (p = 0.6424).ConclusionsCHPR appeared to be a beneficial and effective short-term preoperative rehabilitation protocol, especially in patients with poor preoperative conditions.

An international review and meta-analysis of prehabilitation compared to usual care for cancer patients

“…However, enhanced benefits relating to urinary incontinence were found for prehabilitative PFMT [19]. Other studies not included in the review (because they did not meet one or more eligibility criteria) found improved outcomes for patients in the prehabilitation versus rehabilitation period, for example, combined interventions for patients with colorectal (exercise, nutrition and counselling) [30] or lung cancer (exercise and nutrition) [31]. Pre-operative exercise for lung cancer patients was associated with a number of benefits for patients [32].…”

The key questions in rehabilitation in thoracic surgery

“…amegroups.com/public/system/jtd/jtd.2018.03.147-1. pdf) (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). summarises the key findings, in brief, studies reported a statistically significant improvement in peak oxygen consumption (VO2max) or in functional capacity measured with the 6-minute walk test from baseline to postintervention.…”

Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy

“…Previous groups have recommended intensive preoperative respiratory rehabilitation (PR) for patients undergoing thoracic surgery [7,8] . This PR program is able to reinforce the respiratory muscle strength, lung volume and diaphragmatic excursion [9] .…”