Intensive preoperative rehabilitation improves functional capacity and postoperative hospital length of stay in elderly patients with lung cancer [commentary]

摘要

Summary of: Lai Y, Huang J, Yang M, Su J, Liu J, Che G. Seven-day function, 6-minutewalk distance and quality of life (EuropeanOrganiza- intensive preoperative rehabilitation for elderly patients with lung tion forResearchandTreatmentofCancerQLQ-C30andLC13_CNVersion cancer: a randomized controlled trial. J Surg Res. 2017;209:30-36. 3) collected before and after the preoperative rehabilitation period. Results: The intervention group had a lower incidence of postoperative Question: In elderly patients undergoing thoracic surgery for non-small pulmonary complications (13.3% versus 36.7%, ARR = 0.23, 95% CI 0.01 to cell lung cancer, does a program of preoperative rehabilitation decrease 0.43). The intervention group had a shorter postoperative and total in- postoperative pulmonary complications? Design: Randomised, con- hospital length of stay (mean difference 3.8 days, 95% CI 1.0 to 6.6 and trolled trial with outcome assessor blinding. Setting: A single Chinese 3.7 days, 95% CI 0.8 to 6.6, respectively). The intervention group also hospital.Participants: Inclusioncriteriawerebeing aged 70 yearswith demonstrated a greater increase in 6-minute walk distance (mean dif- a definite diagnosis of primary non-small cell lung cancer and a willing- ference in change 19.2 m, 95% CI 2.1 to 36.3) and peak expiratory flow ness to undergo lobectomy via thoracic surgery. Exclusion criteria were: (meandifference18.0 l/min, 95%CI8.9 to 27.1) butnootherdifferences in oxygen saturation < 90% during the 6-minute walk test, high risk of respiratory function tests or quality of life. Conclusion: A program of adverseevents (myocardial infarctionor cerebrovascularaccident inpast preoperative rehabilitation therapy reduced postoperative pulmonary year, unstable angina, aneurysm, haemoptysis, severe arrhythmia, mus- complications and hospital length of stay, and increased functional culoskeletal ormental disorder) or sub-resection/pneumonectomy. Ran- capacity in elderly thoracic surgery patients with non-small cell lung domisation of 60 participants allocated 30 to an intervention group and cancer. _2I[TFD$F]D1 95% CIs for postoperative pulmonary complications, postopera- 30 to a control group. Interventions: Participants in the intervention tive and in-hospital length of stay calculated by the CAP Editor_DFF]3[F1D0[_TT.DF$1I]ID$ ] group received 7 days of rehabilitation, which comprised breathing exercises (performed on the ward three times/day) and aerobic endur- Provenance: Invited. Not peer reviewed. ance training via a recumbent cross trainer with resistance set by the patient (performed in a rehabilitation centre for 30 min/day). Partici- pants in the control group received usual preoperative care. Outcome Elizabeth H Skinner measures: The primary outcomewas the 30-day incidence of postopera- Department of Physiotherapy, Monash University, Australia tive pulmonary complications. Secondary outcomes included postoper- ative and total in-hospital length of stay, measures of resting lung http://dx.doi.org/10.1016/j.jphys.2017.05.004IF1[]_TDF$1D ? 2017 Published by Elsevier B.V. on behalf of Australian Physiotherapy Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).