SESSION TYPE: Thoracic Surgery I
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: Although surgical resection is the standard treatment of choice for early stage lung cancer, a significant fraction of patients develops postoperative complications due to poor preoperative conditions. To decrease the risk of morbidity, improving pulmonary function and general conditioning preoperatively should be considered essential for patients scheduled to undergo lung surgery. To date, there is no established protocol for preoperative pulmonary rehabilitation, primarily because short-term program is mandatory for patients with malignant disease to undergo surgery without delay.
METHODS: We began conventional preoperative pulmonary rehabilitation (CVPR) in 2006. From June 2009, comprehensive pulmonary rehabilitation (CHPR) was conducted prospectively using a multidisciplinary team approach. CHPR protocol consisted of multiple appointments with the physical therapist and registered dietician, and included intensive nutrition support with branched-chain amino acids (BCAAs) and herbal medicine supplementation. The transitions of pulmonary function and postoperative outcomes in CVPR (n = 29) and CHPR (n = 21) were assessed.
RESULTS: The pre- and post-vital capacity (VC) in the CHPR group were 2.63 ± 0.65 L and 2.75 ± 0.63 L (p = 0.0043), respectively; however, transition of those in the CVPR group was not statistically significant (p = 0.6815). The pre- and post-forced expiratory volume in one second (FEV1) in the CHPR group were 1.73 ± 0.46 L and 1.87 ± 0.46 L (p = 0.0012), respectively; however, transition of those in the CVPR group was not statistically significant (p = 0.6424). Morbidities in the CVPR and CHPR groups among patients with Charlson Comorbidity Index scores ≥2 were 68.8% and 27.3%, respectively (p = 0.0341), and those among patients with preoperative risk score in Estimation of Physiologic Ability and Surgical Stress scores >0.3 were 57.9% and 21.4%, respectively (p = 0.0362).
CONCLUSIONS: This study demonstrated that CHPR appeared to substantially improve pulmonary function and decrease morbidity, especially among patients with poor preoperative conditions.
CLINICAL IMPLICATIONS: We demonstrated the clinical benefit of CHPR protocol with short-term preoperative pulmonary rehabilitation in this study; however, prospective randomized studies should be conducted before such treatment can be recommended in routine clinical practice.