Effects of early rehabilitation therapy in enhanced recovery after surgery mode on postoperative pulmonary function and exercise capacity in lung cancer patients_West China Medical Journal

Authors：

SUN Xin ¹ , HAN Dingpei ² , HUANG Zhuoqiong ³ , WANG Pu ¹ ,  LI Hecheng ²

1. Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China;
2. Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China;
3. Department of Respiratory Medicine, Luwan Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China;

Corresponding?author：

LI Hecheng, Email: LHC11863@rjh.com.cn

Keywords：

Enhanced recovery after surgery; Rehabilitation therapy; Lung neoplasms; Pulmonary lobectomy

DOI：

10.7507/1002-0179.201903124

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Objective To explore the effects of rehabilitation therapy on postoperative pulmonary function and exercise capacity of patients with lung cancer during the hospitalization in the setting of enhanced recovery after surgery (ERAS) protocols.Methods A total of 110 lung cancer patients undergoing thoracoscopic lobectomy in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to December 2018 were randomly divided into the rehabilitation treatment group (the trial group, n=54) and the non-rehabilitation treatment group (the control group, n=56). The trial group got out of bed within 24 hours after surgery and performed respiratory rehabilitation training. The control group did not receive rehabilitation after surgery. Pulmonary function and 6-minute walking distance (6MWD) were evaluated preoperatively and prior to discharge in both groups to compare the differences in pulmonary function and exercise capacity between the two groups.Results The preoperative forced vital capacity (FVC) in the trial group and the control group were (2.45±0.57) and (2.47±0.61) L, respectively; the forced expiratory volume in the first second (FEV₁) were (2.29±0.55) and (2.22±0.55) L, respectively; 6MWD were (592±51) and (576±57) m, respectively; the differences between the two groups were not statistically significant (P>0.05). Prior to discharge, the FVC in the trial group and the control group were (1.43±0.36) and (1.19±0.33) L, respectively; FEV₁ were (1.28±0.32) and (1.06±0.61) L, respectively; 6MWD were (264±43) and (218±37) m, respectively. The results of pre-discharge evaluation were significantly lower than those of preoperative evaluation (P<0.01). The pre-discharge FVC, FEV₁, and 6MWD in the trial group were significantly superior to those in the control group (P<0.01).Conclusion In the setting of ERAS protocols, postoperative rehabilitation therapy during hospitalizations can improve pulmonary function and promote the recovery of exercise capacity in lung cancer patients more effectively.

Citation： SUN Xin, HAN Dingpei, HUANG Zhuoqiong, WANG Pu, LI Hecheng. Effects of early rehabilitation therapy in enhanced recovery after surgery mode on postoperative pulmonary function and exercise capacity in lung cancer patients. West China Medical Journal, 2019, 34(8): 912-916. doi: 10.7507/1002-0179.201903124 Copy

1.	Chen W, Zheng R, Zuo T, et al. National cancer incidence and mortality in China, 2012. Chin J Cancer Res, 2016, 28(1): 1-11.
2.	Maeda K, Higashimoto Y, Honda NA, et al. Effect of a postoperative outpatient pulmonary rehabilitation program on physical activity in patients who underwent pulmonary resection for lung cancer. Geriatr Gerontol Int, 2016, 16(5): 550-555.
3.	Bobbio A, Chetta A, Ampollini L, et al. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg, 2008, 33(1): 95-98.
4.	Lima LN, da Silva RA, Gross JL, et al. Assessment of pulmonary function and quality of life in patients submitted to pulmonary resection for cancer. J Bras Pneumol, 2009, 35(6): 521-528.
5.	車國衛, 李為民, 劉倫旭. 快速肺康復需要圍手術期流程優化. 中國胸心血管外科臨床雜志, 2016, 23(3): 216-220.
6.	Muehling BM, Hatter GL, Schelzig HA, et al. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg, 2008, 34(1): 174-180.
7.	Jones NL, Edmonds L, Ghosh S, et al. A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia, 2013, 68(2): 179-189.
8.	周清華, 范亞光, 王穎, 等. 中國肺部結節分類、診斷與治療指南(2016年版). 中國肺癌雜志, 2016, 19(12): 793-798.
9.	許文延. 肺切除患者術后24h內早期下床活動的安全性與可行性評價. 中國現代醫生, 2013, 51(25): 22-23.
10.	Joseph C, Gaillat F, Duponq RA, et al. Is there any benefit to adding intravenous ketamine to patient-controlled epidural analgesia after thoracic surgery? A randomized double-blind study (dagger). Eur J Cardiothorac Surg, 2012, 42(4): E58-E65.
11.	李磊, 李靜, 喻鵬銘, 等. 胸科物理治療技術及臨床研究. 中國康復, 2015, 30(1): 49-53.
12.	Laursen L?, Petersen RH, Hansen HJ, et al. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg, 2016, 49(3): 870-875.
13.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
14.	Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg, 2008, 248(2): 189-198.
15.	陳美嬌, 林玉琴, 伍景紅. 肺癌術后患者實施系統早期康復訓練的護理效果. 齊齊哈爾醫學院學報, 2014, 35(10): 1548-1549.
16.	劉娜, 王溪婷. 醫護一體化呼吸功能鍛煉在促進胸外科患者術后肺功能康復中的應用效果. 國際護理學雜志, 2018, 37(3): 349.
17.	Brocki BC, Westerdahl E, Andreasen JJ, et al. Improvements in physical performance and health-related quality of life one year after radical operation. Cancer Treat Commun, 2015, 4: 65-74.
18.	Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS?) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
19.	Pryor JA, Prasad SA. 成人和兒童呼吸與心臟問題的物理治療. 喻鵬銘, 車國衛, 譯. 北京: 北京大學醫學出版社, 2011: 3-11, 125, 127-128, 132-133, 141.
20.	Frownfelter D, Dean E. 心血管系統與呼吸系統物理治療證據到實踐. 郭琪, 曹鵬宇, 喻鵬銘, 譯. 北京: 北京科學技術出版社, 2017: 292-295, 467-468.
21.	Miyoshi S, Yoshimasu T, Hirai T, et al. Exercise capacity of thoracotomy patients in the early postoperative period. Chest, 2000, 118(2): 384-390.
22.	Balke B. A simple field test for the assessment of physical fitness. Rep Civ Aeromed Res Inst US, 1963: 1-8.
23.	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the sixminute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.

1. Chen W, Zheng R, Zuo T, et al. National cancer incidence and mortality in China, 2012. Chin J Cancer Res, 2016, 28(1): 1-11.
2. Maeda K, Higashimoto Y, Honda NA, et al. Effect of a postoperative outpatient pulmonary rehabilitation program on physical activity in patients who underwent pulmonary resection for lung cancer. Geriatr Gerontol Int, 2016, 16(5): 550-555.
3. Bobbio A, Chetta A, Ampollini L, et al. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg, 2008, 33(1): 95-98.
4. Lima LN, da Silva RA, Gross JL, et al. Assessment of pulmonary function and quality of life in patients submitted to pulmonary resection for cancer. J Bras Pneumol, 2009, 35(6): 521-528.
5. 車國衛, 李為民, 劉倫旭. 快速肺康復需要圍手術期流程優化. 中國胸心血管外科臨床雜志, 2016, 23(3): 216-220.
6. Muehling BM, Hatter GL, Schelzig HA, et al. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg, 2008, 34(1): 174-180.
7. Jones NL, Edmonds L, Ghosh S, et al. A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia, 2013, 68(2): 179-189.
8. 周清華, 范亞光, 王穎, 等. 中國肺部結節分類、診斷與治療指南(2016年版). 中國肺癌雜志, 2016, 19(12): 793-798.
9. 許文延. 肺切除患者術后24h內早期下床活動的安全性與可行性評價. 中國現代醫生, 2013, 51(25): 22-23.
10. Joseph C, Gaillat F, Duponq RA, et al. Is there any benefit to adding intravenous ketamine to patient-controlled epidural analgesia after thoracic surgery? A randomized double-blind study (dagger). Eur J Cardiothorac Surg, 2012, 42(4): E58-E65.
11. 李磊, 李靜, 喻鵬銘, 等. 胸科物理治療技術及臨床研究. 中國康復, 2015, 30(1): 49-53.
12. Laursen L?, Petersen RH, Hansen HJ, et al. Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy. Eur J Cardiothorac Surg, 2016, 49(3): 870-875.
13. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
14. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg, 2008, 248(2): 189-198.
15. 陳美嬌, 林玉琴, 伍景紅. 肺癌術后患者實施系統早期康復訓練的護理效果. 齊齊哈爾醫學院學報, 2014, 35(10): 1548-1549.
16. 劉娜, 王溪婷. 醫護一體化呼吸功能鍛煉在促進胸外科患者術后肺功能康復中的應用效果. 國際護理學雜志, 2018, 37(3): 349.
17. Brocki BC, Westerdahl E, Andreasen JJ, et al. Improvements in physical performance and health-related quality of life one year after radical operation. Cancer Treat Commun, 2015, 4: 65-74.
18. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS?) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
19. Pryor JA, Prasad SA. 成人和兒童呼吸與心臟問題的物理治療. 喻鵬銘, 車國衛, 譯. 北京: 北京大學醫學出版社, 2011: 3-11, 125, 127-128, 132-133, 141.
20. Frownfelter D, Dean E. 心血管系統與呼吸系統物理治療證據到實踐. 郭琪, 曹鵬宇, 喻鵬銘, 譯. 北京: 北京科學技術出版社, 2017: 292-295, 467-468.
21. Miyoshi S, Yoshimasu T, Hirai T, et al. Exercise capacity of thoracotomy patients in the early postoperative period. Chest, 2000, 118(2): 384-390.
22. Balke B. A simple field test for the assessment of physical fitness. Rep Civ Aeromed Res Inst US, 1963: 1-8.
23. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the sixminute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.

West China Medical Journal

Effects of early rehabilitation therapy in enhanced recovery after surgery mode on postoperative pulmonary function and exercise capacity in lung cancer patients

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