Abstract
Influence of physiotherapy on the outcome of the lung resection is still controversial. Study aim was to assess the influence of physiotherapy program on postoperative lung function and effort tolerance in lung cancer patients with chronic obstructive pulmonary disease (COPD) that are undergoing lobectomy or pneumonectomy. The prospective study included 56 COPD patients who underwent lung resection for primary non small-cell lung cancer after previous physiotherapy (Group A) and 47 COPD patients (Group B) without physiotherapy before lung cancer surgery. In Group A, lung function and effort tolerance on admission were compared with the same parameters after preoperative physiotherapy. Both groups were compared in relation to lung function, effort tolerance and symptoms change after resection. In patients with tumors requiring a lobectomy, after preoperative physiotherapy, a highly significant increase in FEV1, VC, FEF50 and FEF25 of 20%, 17%, 18% and 16% respectively was registered with respect to baseline values. After physiotherapy, a significant improvement in 6-minute walking distance was achieved. After lung resection, the significant loss of FEV1 and VC occurred, together with significant worsening of the small airways function, effort tolerance and symptomatic status. After the surgery, a clear tendency existed towards smaller FEV1 loss in patients with moderate to severe, when compared to patients with mild baseline lung function impairment. A better FEV1 improvement was associated with more significant loss in FEV1. Physiotherapy represents an important part of preoperative and postoperative treatment in COPD patients undergoing a lung resection for primary lung cancer.
Highlights
During the previous decade, functional assessment of patients that were diagnosed with lung cancer that are undergoing surgery significantly changed
Changes in effort tolerance and symptomatic status after preoperative physiotherapy After preoperative physiotherapy program, a significant improvement in 6MWD was achieved, with an average gain of 53m (16%, p
A positive correlation was found between the gain in FEV1 and prolongation of the 6MWDduring the preoperative treatment (r=0.37, p=0.005), (Fig. 1A).A symptom relief after preoperative physiotherapy followed the same trend both in candidates for lobectomy (Table 2) and pneumonectomy (Table 3)
Summary
Functional assessment of patients that were diagnosed with lung cancer that are undergoing surgery significantly changed. We have demonstrated beneficial effects of respiratory rehabilitation for patients with chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer [7]. The aim of the study is to assess the influence of physiotherapy program on postoperative lung function and effort tolerance in lung cancer patients with chronic obstructive pulmonary disease (COPD) that are undergoing lobectomy or pneumonectomy. Comparisons of preoperative respiratory function and effort tolerance tests before and after physiotherapy program with the same tests performed postoperatively will be applied. These findings will be further compared with a group of COPD patients without preoperative physiotherapy
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