Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: A study for 342 cases

Ke Gao, Peng-Ming Yu, Jian-Hua Su, Cheng-Qi He, Lun-Xu Liu, Yu-Bin Zhou, Qiang Pu, Guo-Wei Che, Ke Gao, Peng-Ming Yu, Jian-Hua Su, Cheng-Qi He, Lun-Xu Liu, Yu-Bin Zhou, Qiang Pu, Guo-Wei Che

Abstract

Background: An evaluation of cardiopulmonary exercise testing (CPET) screening and pre-operative pulmonary rehabilitation in reducing postoperative complications and improving fast-track recovery in high-risk patients who undergo resection for lung cancer.

Methods: Of 342 potential lung cancer cases, 142 high-risk patients were finally divided into two groups: group R (n = 71) underwent an intensive pre-operative pulmonary rehabilitation program (PRP), followed by lobectomy; group S (n = 71) underwent only lobectomy with conventional management. Postoperative complications, average days in hospital, postoperative days in hospital, and cost were analyzed.

Results: The 142 high-risk patients were screened by smoking history and CPET. Sixty-eight patients had bronchial hyperresponsiveness (BHR) and 47 patients had peak expiratory flow <250 L/minute by CPET. The rate of postoperative total complications in group R (16.90%) was significantly lower than in group S (83.31%) (P = 0.00), as was the rate of postoperative pulmonary complications PPC: group R (12.81%) versus S (13.55%) (P = 0.009); the PPC in the left lung (17.9%) was higher than in the right lung (2.3%) (P = 0.00). The average days in hospital in group S was significantly higher than in group R (P = 0.03). There was no difference between groups in average hospital cost (P = 0.304).

Conclusion: Pre-operative screening using CPET is conducive to identifying high-risk patients for lung resection. Pre-operative pulmonary rehabilitation is helpful to reduce postoperative complications and improve fast-track recovery.

Keywords: Cardiopulmonary exercise testing (CPET); fast-track recovery; lung cancer surgery; pulmonary rehabilitation (PR) program.

Figures

Figure 1
Figure 1
Diagram for patient selection. CPET, cardiopulmonary exercise testing; FEV1, forced expiratory volume in one second; PEF, peak expiratory flow; PR, pulmonary rehabilitation.

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