br Preoperative rehabilitation Severe pulmonary function
Preoperative rehabilitation Severe pulmonary function impairment was considered inoperable in approximately 37% of patients with anatomically resectable lung cancer. The surgical morbidity and mortality rates for patients at an acceptable risk of perioperative complications were 31.6% and 4.3%, respectively, whereas those at high risk were 83.3% and 33.3%, respectively. Acknowledging the severity of this problem allows clinicians to develop a more effective preoperative management strategies that could better prepare patients for surgery. Prehabilitation exercise should be undertaken prior to surgery or treatment for two primary reasons. The first is to optimize the physical status and overall medical stability before surgery and reduce postoperative morbidity in operable patients. Two systemic reviews and one meta-analysis study concluded that pre-surgical interventions based on moderate-to-intense aerobic exercise in lung cancer patients undergoing lung resection could improve pulmonary function (Force Vital Capacity (FVC) and FEV1) and functional capacity significantly before surgery, reduce postoperative morbidity (risk ratios = 0.45) and in-hospital length of stay (LOS) (mean difference = −4.83). However, interventions performed only during the postoperative calcium channel blocker did not seem to reduce postoperative pulmonary complications (PPCs) or LOS. Since physical training programs differed in every study, it was not possible to identify the best preoperative intervention due to the paucity of clinical trials in this area. The second reason is to increase the percentage of operable cases by improving the physical status of a patient who was initially considered inoperable due to cardiopulmonary impairment to become a candidate for potentially curative surgery. As earlier discussed, exercise capacity might discriminate between patients who can and cannot tolerate surgery, thereby allowing a greater number of patients to receive a potentially curative operation. Two studies evaluated the role of short-term preoperative pulmonary rehabilitation on exercise capacity for inoperable patients to sufficiently improve their physical status surgery. In the prospective observational study, the recruitment criteria were patients with COPD alone or with lung cancer, and subjects whose VO2 max cardiopulmonary exercise test was less than or equal to 15 mL/kg/min. Overall, 12 patients fulfilled the inclusion criteria, who completed the preoperative rehabilitation that consisted of 1 ½ hour sessions daily, five sessions per week for four weeks. The program included breathing and coughing techniques, incentive spirometry exercises and cycling. After training, the patients\' exercise performances were significantly improved. The mean VO2 max had increased to 2.8 mL/kg/min, whereas the pulmonary function test and diffuse lung capacity were unchanged. Also, 11 of the patients underwent lobectomy with no postoperative mortality noted, and the mean hospital stay was 17 days. Postoperative pulmonary complication happened in eight patients. In another pilot study, eight lung cancer patients who were inoperable due to poor pulmonary function underwent a four-week preoperative rehabilitation—five daily sessions, 3 h each, every week— including incremental symptom-limited aerobic exercise, breathing exercises, and educational sessions. All of the patients improved their exercise capacity as parenchyma affects clinical criteria for surgery, and were subsequently operated on with no mortality and a morbidity of 25%. Functional parameters measured before and after preoperative rehabilitation demonstrated a significant increase in FVC, both in terms of volume (+0.44 l) and percentage of that predicted (+12.9%). Similar improvements, although to a lesser extent, were observed for FEV1. General performance in the 6-min walk test (6 MWT) improved by 47.4%. The strong correlation between prehabilitation values and the indices of FEV1, 6 MWT, and arterial oxygen tension (paO2) after surgical treatment indicated that patients who had the worst initial pulmonary function and exercise capacity received the most benefits from pulmonary rehabilitation.