Prehabilitation in thoracic surgery

Abstract

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.

Enhanced recovery after surgery (ERAS) programs for esophagectomy

“…Available data also shows that frailty rather than age is a major risk factor of perioperative complications (15). This evidence suggests including patient tailored physical activity in the time between diagnosis and the surgical procedure (16)(17)(18). Careful communication with the patients is of utter importance.…”

Preoperative high-intensity interval training is effective and safe in deconditioned patients with lung cancer: A randomized clinical trial

“…A potential curative option for early-stage nonsmall cell lung cancer (NSCLC) is primary lung resection (1). However, physical deconditioning is a major risk factor for patients undergoing surgery, and low peak oxygen uptake (VO 2peak ) is a predictor of perioperative mortality and cardiopulmonary morbidity (2,3).…”

Effects of progressive Orff vocal therapy on BODE index and quality of life in patients with low lung function after non-small cell lung cancer surgery

“…16,17 The FACT-L version 4.0 used in this study is a Chinese version equivalent to 2000 Chinese finished by Wan Chonghua. It includes a common module consisting of a total of 34 items (physical status (8), social/ family status (8), relationship with doctors (3), emotional status (7), and functional status (8)) (i.e. The general scale of cancer treatment function evaluation (FACT-G) and the specific module used by NSCLC patients only (that is, the 10-item NSCLC additional focus part) are composed of two parts.…”

“…5,6 Several studies in recent years have confirmed that lung rehabilitation training such as respiratory function exercise and muscle exercise have a positive effect on the rehabilitation of lung function after NSCLC. 7,8 However, conventional lung rehabilitation training is monotonous and boring, and the patient's compliance is poor, making it difficult to persist after discharge. In addition, patients with malignant tumors often have a series of problems in negative emotions such as anxiety, depression, fear, social function, and emotional status, which are difficult to solve by relying solely on lung rehabilitation.…”