Long-term survival following lung surgery for cancer in high-risk patients after perioperative pulmonary rehabilitation.

OBJECTIVES The benefits of a rehabilitation programme before lung surgical resection for cancer remain to be defined. The purpose of this observational study was to assess the efficacy of preoperative rehabilitation and postoperative rehabilitation on short- and long-term outcomes in patients who were at high operative risk. METHODS Between January 2010 and December 2012, 20 consecutive non-operable patients (16 men and 4 women, mean age 66 years) with clinical N0 lung cancer were included. Eligibility criteria were lung function below guideline thresholds and/or associated severe comorbidities. The protocol included a cardiorespiratory perioperative rehabilitation programme. These patients were followed up at 5 years. RESULTS The average increase in forced expiratory volume (FEV)1 and of VO2max preoperatively was 12% and 3.5 ml/kg/min, respectively. All patients underwent a pulmonary surgical resection procedure. The morbidity and mortality rates were 20% and 5%, respectively. Nineteen patients returned home upon the completion of postoperative rehabilitation. After 5-year follow-up, the Kaplan-Meier 5-year survival rate was 52%. CONCLUSIONS Perioperative pulmonary rehabilitation seems to allow surgical management of lung cancer by lung resection in first-line, non-eligible patients. The long-term survival of operated high-risk patients is encouraging despite the high complication rate.

[1]  C. Granger,et al.  Preoperative exercise training for patients with non-small cell lung cancer. , 2017, The Cochrane database of systematic reviews.

[2]  H. Decaluwé,et al.  European risk models for morbidity (EuroLung1) and mortality (EuroLung2) to predict outcome following anatomic lung resections: an analysis from the European Society of Thoracic Surgeons database†,‡ , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[3]  I. Goldsmith,et al.  Impact of preoperative pulmonary rehabilitation on the Thoracoscore of patients undergoing lung resection. , 2016, Interactive cardiovascular and thoracic surgery.

[4]  D. Boffa,et al.  The Natural History of Operable Non-Small Cell Lung Cancer in the National Cancer Database. , 2016, Annals of Thoracic Surgery.

[5]  H. Decaluwé,et al.  Outcome after video-assisted thoracoscopic surgery and open pulmonary lobectomy in patients with low VO2 max: a case-matched analysis from the ESTS database†. , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[6]  P. Bagan,et al.  Prevention of pulmonary complications after aortic surgery: evaluation of prophylactic noninvasive perioperative ventilation. , 2011, Annals of vascular surgery.

[7]  B. Naidu,et al.  Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? , 2011, Interactive cardiovascular and thoracic surgery.

[8]  S. Jaber,et al.  Role of non-invasive ventilation (NIV) in the perioperative period. , 2010, Best practice & research. Clinical anaesthesiology.

[9]  P. Pelosi,et al.  Noninvasive respiratory support in the perioperative period , 2010, Current Opinion in Anaesthesiology.

[10]  P. Papadakos,et al.  Respiratory failure and hypoxemia in the cirrhotic patient including hepatopulmonary syndrome , 2010, Current opinion in anaesthesiology.

[11]  L. Goldman,et al.  The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer. , 2009, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[12]  K. Courneya,et al.  Effects of presurgical exercise training on systemic inflammatory markers among patients with malignant lung lesions. , 2009, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[13]  L. Nici Preoperative and postoperative pulmonary rehabilitation in lung cancer patients. , 2008, Thoracic surgery clinics.

[14]  A. Chetta,et al.  Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[15]  D. Galetta,et al.  Pre-operative pulmonary rehabilitation and surgery for lung cancer. , 2007, Lung cancer.

[16]  M. Santosb,et al.  Efectos fisiológicos de la ventilación no invasiva en pacientes con EPOC , 2007 .

[17]  F. J. Hurtado,et al.  [Physiologic effects of noninvasive ventilation in patients with chronic obstructive pulmonary disease]. , 2007, Archivos de bronconeumologia.

[18]  V. Lawrence,et al.  Preoperative Pulmonary Risk Stratification for Noncardiothoracic Surgery: Systematic Review for the American College of Physicians , 2006, Annals of Internal Medicine.

[19]  R. Morice,et al.  Pulmonary dysfunction as a major cause of inoperability among patients with non-small-cell lung cancer. , 2006, Clinical lung cancer.

[20]  M. Bartels,et al.  Pulmonary rehabilitation in patients undergoing lung-volume reduction surgery. , 2006, Archives of physical medicine and rehabilitation.

[21]  S. M. Lee,et al.  The effects of pulmonary rehabilitation in the national emphysema treatment trial. , 2005, Chest.

[22]  R. Goldstein Rehabilitation and the national emphysema treatment trial. , 2005, Chest.

[23]  A. Iyoda,et al.  Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. , 2005, The Japanese journal of thoracic and cardiovascular surgery : official publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai zasshi.

[24]  V. Ranieri,et al.  Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. , 2005, JAMA.

[25]  B. Celli Chronic respiratory failure after lung resection: the role of pulmonary rehabilitation. , 2004, Thoracic surgery clinics.

[26]  J. Nazarian Cardiopulmonary rehabilitation after treatment for lung cancer , 2004, Current treatment options in oncology.

[27]  J. Wedzicha,et al.  Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. , 2004, The Cochrane database of systematic reviews.

[28]  E. Müller,et al.  Nasal continuous positive airway pressure: A method to avoid endotracheal reintubation in postoperative high-risk patients with severe nonhypercapnic oxygenation failure. , 2000, Chest.

[29]  E F Cook,et al.  Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. , 1999, Circulation.

[30]  M. Moy,et al.  Health-related quality of life improves following pulmonary rehabilitation and lung volume reduction surgery. , 1999, Chest.

[31]  M. Mateu,et al.  Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. , 1998, Archives of physical medicine and rehabilitation.

[32]  Wilson Dj Pulmonary rehabilitation exercise program for high-risk thoracic surgical patients. , 1997 .

[33]  D. Zamir,et al.  The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. , 1997, The Journal of thoracic and cardiovascular surgery.

[34]  D. Wilson Pulmonary rehabilitation exercise program for high-risk thoracic surgical patients. , 1997, Chest surgery clinics of North America.