Abstract
BackgroundPatients undergoing surgery for esophageal cancer have a high risk for postoperative deterioration of lung function and pulmonary complications. This is partly due to one-lung ventilation during thoracotomy. This often accounts for prolonged stay on intensive care units, delayed postoperative reconvalescence and reduced quality of life. Socioeconomic disadvantages can result from these problems. Physical preconditioning has become a crucial leverage to optimize fitness and lung function in patients scheduled for esophagectomy, in particular during the time period of neoadjuvant therapy.Methods/Study designWe designed a prospective multicenter randomized-controlled trial. The objective is to evaluate the impact of an internet-based exercise program on postoperative respiratory parameters and pneumonia rates in patients with Barrett’s carcinoma scheduled for esophagectomy. Patients are randomly assigned to either execute internet-based perioperative exercise program (iPEP), including daily endurance, resistance and ventilation training or treatment as usual (TAU). During neoadjuvant therapy and recovery, patients in the intervention group receive an individually designed intensive exercise program based on functional measurements at baseline. Personal feedback of the supervisor with customized training programs is provided in weekly intervals.DiscussionThis study will evaluate if an intensive individually adapted training program via online supervision during neoadjuvant therapy will improve cardiorespiratory fitness and reduce pulmonary complications following esophagectomy for Barrett’s cancer.Trial registrationNCT02478996, registered 26 May 2015.
Highlights
Patients undergoing surgery for esophageal cancer have a high risk for postoperative deterioration of lung function and pulmonary complications
The objective of this study is to investigate the pulmonary outcomes of physically preconditioned patients with Barrett’s cancer scheduled for esophagectomy who receive physical training during the phase of neoadjuvant therapy
In spite of significant advances in surgical techniques, postoperative intensive care and complication management, esophagectomy is still a high risk-procedure associated with considerable postoperative pulmonary morbidity and mortality
Summary
Patients undergoing surgery for esophageal cancer have a high risk for postoperative deterioration of lung function and pulmonary complications. This is partly due to one-lung ventilation during thoracotomy. Pulmonary complications following esophagectomy are the most common and cost-intensive adverse events, mostly due to prolonged intensive care unit stays This is partly due to one-lung ventilation (OLV) during thoracotomy. A significantly reduced rate of pulmonary infections in patients receiving minimally-invasive treatment versus open surgery was reported [4] This striking result after 2 weeks following surgery might be due to the reduced trauma of thoracoscopy compared to thoracotomy. No routine use of minimallyinvasive surgery and other advances of modern surgical techniques were applied, all studies revealed a very short
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