Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial

Abstract

Background:The feasibility and practicality of preoperative rehabilitation (PR) programs remains quite controversial in the treatment of lung cancer (LC). This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training (IMT).Methods: A three-armed randomized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients. Patient groups received one of three treatment regimens: (I) high-intensity pulmonary rehabilitation (PR) that combined IMT with conventional resistance training (CRT) (combined PR group); (II) conventional PR (single IMT group); or (III) routine preoperative preparation (control group). The primary endpoint was a change in the occurrence of post-operative pulmonary complications (PPCs) that occurred within 30 days after surgery, while secondary endpoints included changes in length of hospital stay, quality of life (QoL) scores, 6-min walk distance (6-MWD) and peak expiratory flow (PEF).Results: A total of 90 enrolled patients were randomized into three groups with a computer-based 1:1:1 ratio. The intention-to-treat analysis of the study revealed that, compared with the Control Group, the Combined PR Group had a significant increase in Conclusions: This hospital-based short-term program of PR combining high-intensity IMT with CRT was significantly superior to the conventional IMT program, indicating that this approach would be a feasible strategy for treating LC patients, especially those waiting operations with surgery-related risk factors.

Preoperative low skeletal muscle mass as a risk factor for pharyngocutaneous fistula and decreased overall survival in patients undergoing total laryngectomy

“…33,34 A randomized controlled trial in patients with lung cancer undergoing short-term intensive rehabilitation prior to radical surgery showed positive results, with a significant decrease in hospital stay after surgery. 35 However, most current trials are small; larger randomized controlled trials should clarify whether a multimodal rehabilitation program can reduce the negative effects of low SMM in patients undergoing TL. Alternatively, treatment planning could take the low SMM into account.…”

“…Feasibility studies in patients with HNC have shown that resistance training programs in patients undergoing chemoradiotherapy or radiotherapy are feasible and show high patient satisfaction . A randomized controlled trial in patients with lung cancer undergoing short‐term intensive rehabilitation prior to radical surgery showed positive results, with a significant decrease in hospital stay after surgery . However, most current trials are small; larger randomized controlled trials should clarify whether a multimodal rehabilitation program can reduce the negative effects of low SMM in patients undergoing TL.…”

Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy

“…The institutional policies for perioperative care, including the preoperative pulmonary rehabilitation, postoperative pain control, lung recruitment assessment and postoperative chest tube management had been reported in our previous studies (2,4,5,15,16).…”

Body surface area as a novel risk factor for chylothorax complicating video‐assisted thoracoscopic surgery lobectomy for non‐small cell lung cancer

“…After surgery, patients were managed in compliance with a standardized clinical pathway. The institutional policies for intensive pulmonary rehabilitation, residual lung recruitment assessment, chest tube management, and discharge criteria, have been reported in our previous studies …”

“…The institutional policies for intensive pulmonary rehabilitation, residual lung recruitment assessment, chest tube management, and discharge criteria, have been reported in our previous studies. 6,12,13,[21][22][23][26][27][28][29] An algorithm of chylothorax management is shown in Figure 1. Once diagnosed with chylothorax, patients were initially managed with oral intake cessation (OIC) and total parenteral nutrition (TPN).…”