Preoperative pulmonary rehabilitation in medical inoperable patients with early stage non-small cell lung cancer and postoperative results

Abstract

Aims: The impact of postoperative complications after surgery for lung cancer is substantial, with the increasing age of patients and the presence of comorbidities. Impairment in exercise capacity is a potential modifiable risk factor for postoperative complications. This study aimed to assess the contribution of preoperative pulmonary rehabilitation (PR) for increasing operability conditions in non-small cell lung cancer (NSCLC) for patients with limited pulmonary functions and postoperative results.
 Methods: The patients with NSCLC who had preoperative pulmonary rehabilitation and underwent surgical resection in our clinics between 2010-2019 were evaluated retrospectively. The patients enrolled in a comprehensive, multidisciplinary, supervised outpatient 10-day duration PR program preoperatively, consisting of bronchial hygiene, breathing control, energy conservation techniques, exercise training (endurance and strength), psychological support, and nutritional support. Exercise capacity and VO2 peak were evaluated by using an incremental shuttle walk test (ISWT).
 Results: Eighteen patients who underwent surgery due to NSCLC and had a pre-operative pulmonary rehabilitation program were evaluated. All the cases were male; the mean age was 66.2 (53-77) years. The squamous cell/adenocarcinoma ratio was 2.6 (13:5), and the mean tumor size was 4.6 (8-18) cm. The postoperative hospital stay was 12.7 (4-42) days, and they were followed up for an average of 30.2 (2-83) months. 
 Conclusion: Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD, increasing their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention for risk modification and to decrease surgical morbidity and mortality. The results of our study also revealed the importance of preoperative pulmonary rehabilitation in centers where lung cancer surgery was performed.