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Respiratory Physiotherapy Intervention Strategies in the Sequelae of Breast Cancer Treatment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073800. [PMID: 35409486 PMCID: PMC8997605 DOI: 10.3390/ijerph19073800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/10/2022] [Accepted: 03/19/2022] [Indexed: 02/05/2023]
Abstract
Breast cancer treatments can trigger respiratory sequelae. Respiratory physiotherapy helps to eliminate or mitigate the sequelae by optimizing respiratory function. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of respiratory physiotherapy in the sequelae of breast cancer. The Cochrane Library, Physiotherapy Evidence Database, PubMed, Web of Science, Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Literature Complete, and Scopus were searched. Study quality was determined using the PEDro scale, STROBE Statement, and Single-Case Experimental Design Scale. Ten studies, six clinical trials, one case study, and three observational studies were selected. The mean methodological quality of the clinical trials was 5.6, that of the case study was 7, and that of the observational studies was 56%. Respiratory physiotherapy has been observed to improve respiratory capacity, lung function, respiratory muscle strength, effort tolerance, dyspnea, fatigue, thoracic mobility, upper limb volume, sleep quality and quality of life, as well as sensitivity to adverse physiological reactions, nausea, vomiting, and anxiety. However, it is not effective for vasomotor symptoms. More clinical trials are needed. These studies should homogenize the techniques used, as well as improve their methodological quality.
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Gilgado D, Pérez Calvo E, Pérez J, Dorado J, Cardoso G, Quiroga C, Scapellato J, Plotnikow G, Accoce M. Assessment of the effect of respiratory physiotherapy techniques on end-expiratory lung volume through electrical impedance tomography in healthy subjects. Med Intensiva 2021; 45:e53-e55. [PMID: 34839887 DOI: 10.1016/j.medine.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Affiliation(s)
- D Gilgado
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina.
| | - E Pérez Calvo
- Rehabilitation and Weaning Center, Clínica Basilea, CABA, Argentina
| | - J Pérez
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
| | - J Dorado
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
| | - G Cardoso
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
| | - C Quiroga
- Intensive Care Unit, Sanatorio Anchorena Recoleta, CABA, Argentina
| | - J Scapellato
- Intensive Care Unit, Sanatorio Anchorena Recoleta, CABA, Argentina
| | - G Plotnikow
- Intensive Care Unit, Sanatorio Anchorena Recoleta, CABA, Argentina
| | - M Accoce
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
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Lähteenmäki SI, Sioris T, Mahrberg HSS, Rinta-Kiikka IC, Laurikka JO. A randomized trial comparing inspiratory training and positive pressure training in immediate lung recovery after minor pleuro-pulmonary surgery. J Thorac Dis 2021; 13:4690-4702. [PMID: 34527310 PMCID: PMC8411129 DOI: 10.21037/jtd-21-473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/21/2021] [Indexed: 11/12/2022]
Abstract
Background Two respiratory physiotherapy modalities were compared in a randomized controlled trial on patients undergoing minor pleuro-pulmonary surgery. Methods Forty-five patients were randomly allocated into positive expiratory pressure (PEP) therapy (n=23) and inspiratory muscle training (IMT) groups (n=22). Individualized group specific physiotherapeutic guidance was administered preoperatively, and once a day postoperatively. Patients also performed independent exercises and kept a logbook. Pain was assessed on a numerical reference scale (NRS). Volumetric pulmonary function values and walking distance were recorded preoperatively, and on first (POD1) and second postoperative days (POD2). Pre- and postoperative values were compared using two-way repeated measures analysis of variance. Results Patient characteristics and pleuro-pulmonary interventions were similar between the groups. Thoracotomy was performed in 14/45 and video assisted surgery (VATS) in 31/45 of cases. Preoperative volumetric pulmonary functions were normal or slightly decreased in 29/45, and fell significantly (P<0.001) on the first postoperative day (POD1) and improved but remained significantly lower on the second postoperative day. The recovery of mean FEV1, FIV1 and FIVC values was greater in the IMT than in the PEP group between POD1 and POD2, but without significant difference. The corresponding relative to preoperative values were higher in the IMT group, with a significant difference in FEV1 (P=0.045). Also relative PEF and FIV1 values seemed to be slightly higher in the IMT compared to the PEP group, but not significantly. Average NRS values for pain were lower in the IMT group (P=0.010) but only on POD1. Air leak was noted in 4/45 patients, two in each group, on POD1, and two in PEP groups and one in IMT group on POD2. Mean measured walking distances between groups did not differ. Mean hospital stay was 4 days in the PEP group and 3 days in the IMT group. There was no hospital mortality. Conclusions Pulmonary function values decreased significantly after minor lung resections, supporting rehabilitative respiratory physiotherapy to avoid postoperative pulmonary complications (PPCs). Both PEP and IMT training were well tolerated and equally efficient when comparing spirometry values at three time points. IMT appeared advantageous regarding relative FEV1 recovery and immediate postoperative pain.
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Affiliation(s)
- Sabina Isabel Lähteenmäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere Heart Hospital, Tampere, Finland
| | | | | | - Irina C Rinta-Kiikka
- Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Jari O Laurikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere Heart Hospital, Tampere, Finland
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Lim Y, Lee H, Kim DH, Kim YD. [Applying Extended Theory of Planned Behavior for Lung Cancer Patients Undergone Pulmonary Resection: Effects on Self-Efficacy for Exercise, Physical Activities, Physical Function, and Quality of Life]. J Korean Acad Nurs 2020; 50:66-80. [PMID: 32131074 DOI: 10.4040/jkan.2020.50.1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/05/2019] [Accepted: 01/19/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aims to examine the effects of nursing interventions based on the Extended Theory of Planned Behavior (ETPB) regarding self-efficacy for exercise (SEE), physical activity (PA), physical function (PF), and quality of life (QOL) in patients with lung cancer who have undergone pulmonary resection. METHODS This quasi-experimental study was conducted between July 2015 and June 2018 in two university-affiliated hospitals. The intervention included pre-operative patient education, goal setting (action and coping planning), and feedback (behavior intention and perceived behavioral control). The intervention group (IG) (n=51) received nursing interventions from the day before surgery to 12 months after lung resection, while the comparison group (CG) (n=36) received usual care. SEE, PA, PF (dyspnea, functional status, and 6-minute walking distance [6MWD]), and QOL were measured before surgery and at one, three, six, and 12 months after surgery. Data were analyzed using the χ² test, Fisher's exact test, Mann-Whitney U test, t-test, and generalized estimation equations (GEE). RESULTS There were significant differences between the two groups regarding SEE (χ²=13.53, p=.009), PA (χ²=9.51, p=.049), functional status (χ²=10.55, p=.032), and 6MWD (χ²=15.62, p=.004). Although there were no time or group effects, the QOL mental component (Z=-2.78, p=.005) of the IG was higher than that of the CG one month after surgery. Interventions did not affect dyspnea or the QOL physical component. CONCLUSION The intervention of this study was effective in improving SEE, PA, functional status, and 6MWD of lung cancer patients after lung resection. Further extended investigations that utilize ETPB are warranted to confirm these results.
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Affiliation(s)
- Yeonjung Lim
- College of Nursing, Pusan National University, Yangsan, Korea
| | - Haejung Lee
- College of Nursing, Pusan National University, Yangsan, Korea.
| | - Do Hyung Kim
- Pulmonary Medicine Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea
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Lähteenmäki S, Sioris T, Mahrberg H, Rinta-Kiikka I, Laurikka J. Inspiratory training and immediate lung recovery after resective pulmonary surgery: a randomized clinical trial. J Thorac Dis 2020; 12:6701-6711. [PMID: 33282371 PMCID: PMC7711407 DOI: 10.21037/jtd-20-1668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Prompt and uneventful recovery after resective pulmonary surgery benefits patients by decreasing length and total costs of hospital stay. Postoperative physiotherapy has been shown to be advantageous for patient recovery in several studies and lately inspiratory muscle training (IMT) physiotherapy has been used also in thoracic patients. This randomized controlled trial intended to evaluate whether IMT is an efficient and feasible method of physiotherapy compared to water bottle positive expiratory physiotherapy (PEP) immediately after lung resections. Methods Forty-two patients were randomly allocated into two intervention groups: water bottle PEP (n=20) and IMT group (n=22). Patients were given physiotherapeutic guidance once a day and patients were also instructed to do independent exercises. Measurements of pulmonary function were compared between the treatment groups according to intention to treat by using two-way repeated measures analysis of variances at three time points (preoperative, first postoperative day, and second postoperative day). Walking distance was measured at first and second postoperative day and similarly, evaluation of postoperative air leak during exercises was performed. Physiotherapy was modified or temporarily interrupted, if necessary, because of the air leak. Results Postoperative pulmonary function tests were equal between the intervention groups. Air leak was relatively common after lung resections: 31% of all patients had mild or moderate/severe air leak at first postoperative day and 14% of all patients had mild to severe air leak at second postoperative day respectively. There were no statistically significant differences in occurrence of air leak between intervention groups, but water resistance had to be reduced or physiotherapy discontinued significantly more often among the water bottle PEP group patients (P=0.01). Walking distance improved slightly faster in the IMT group between the first and the second postoperative day when compared to the water bottle PEP group, but the difference between the groups was not statistically significant. Conclusions IMT physiotherapy is equally effective to water bottle PEP training in postoperative physiotherapy after lung resection surgery evaluated with pulmonary function tests and walking distance. In addition, IMT physiotherapy is safe and more feasible form of physiotherapy during postoperative air leak compared to water bottle PEP.
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Affiliation(s)
- Sabina Lähteenmäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere Heart Hospital, Tampere, Finland
| | | | | | - Irina Rinta-Kiikka
- Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Jari Laurikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tampere Heart Hospital, Tampere, Finland
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Is respiratory physiotherapy effective on pulmonary complications after lobectomy for lung cancer? TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:638-647. [PMID: 33403137 PMCID: PMC7759043 DOI: 10.5606/tgkdc.dergisi.2020.19693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/01/2020] [Indexed: 11/29/2022]
Abstract
Background
The aim of this study was to investigate the effects of a postoperative respiratory physiotherapy program on pulmonary complications, length of hospital stay, and hospital cost after lobectomy for lung cancer.
Methods
A total of 90 patients (75 males, 15 females; mean age 63.1±10.4 years; range, 30 to 82 years) who underwent elective lobectomy through thoracotomy due to lung cancer between June 2014 and December 2019 were retrospectively analyzed. The patients were divided into two groups as Group S who received standard postoperative care (n=50) and Group P who received postoperative respiratory physiotherapy in addition to standard care (n=40). Both groups were compared in terms of postoperative pulmonary complications, 30-day mortality, length of hospital stay, and hospital cost.
Results
The preoperative and surgical characteristics of the groups were similar. Group P had a lower incidence of postoperative pulmonary complications (10% vs. 38%, respectively; p=0.002) than Group S. The median length of stay in the hospital was six (range, 4 to 12) days in Group P and seven (range, 4 to 40) days in Group S (p=0.001). The drug cost (639.70 vs. 1,211.46 Turkish Liras, respectively; p=0.001) and the total hospital cost (2,031.10 vs. 3,778.68 Turkish Liras, respectively; p=0.001) of the patients in Group P were significantly lower. The multivariate logistic regression analysis showed that respiratory physiotherapy had a protective effect on the development of postoperative pulmonary complications (odds ratio =0.063, 95% confidence interval: 0.010-0.401, p=0.003).
Conclusion
An intensive physiotherapy program focusing on respiratory exercises is a cost-effective practice which reduces the risk of development of postoperative pulmonary complications in patients undergoing lobectomy for lung cancer.
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Gilgado D, Pérez Calvo E, Pérez J, Dorado J, Cardoso G, Quiroga C, Scapellato J, Plotnikow G, Accoce M. Assessment of the effect of respiratory physiotherapy techniques on end-expiratory lung volume through electrical impedance tomography in healthy subjects. Med Intensiva 2020; 45:S0210-5691(20)30264-3. [PMID: 33071024 DOI: 10.1016/j.medin.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- D Gilgado
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina.
| | - E Pérez Calvo
- Rehabilitation and Weaning Center, Clínica Basilea, CABA, Argentina
| | - J Pérez
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
| | - J Dorado
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
| | - G Cardoso
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
| | - C Quiroga
- Intensive Care Unit, Sanatorio Anchorena Recoleta, CABA, Argentina
| | - J Scapellato
- Intensive Care Unit, Sanatorio Anchorena Recoleta, CABA, Argentina
| | - G Plotnikow
- Intensive Care Unit, Sanatorio Anchorena Recoleta, CABA, Argentina
| | - M Accoce
- Intensive Care Unit, Sanatorio Anchorena San Martín, Buenos Aires, Argentina
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8
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Novoa NM, Fuentes MG. Digital chest drainage vs. water seal chest drainage in the robotic era. J Thorac Dis 2020; 12:3004-3006. [PMID: 32642219 PMCID: PMC7330785 DOI: 10.21037/jtd.2020.03.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nuria M Novoa
- Thoracic Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Salamanca Institute of Biomedical Research (IBSAL), Salamanca, Spain
| | - Marta G Fuentes
- Thoracic Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Salamanca Institute of Biomedical Research (IBSAL), Salamanca, Spain
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Laurent H, Aubreton S, Galvaing G, Pereira B, Merle P, Richard R, Costes F, Filaire M. Preoperative respiratory muscle endurance training improves ventilatory capacity and prevents pulmonary postoperative complications after lung surgery. Eur J Phys Rehabil Med 2020; 56:73-81. [DOI: 10.23736/s1973-9087.19.05781-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Schmidt Leuenberger JM, Hoksch B, Luder G, Schmid RA, Verra ML, Dorn P. Early Assessment and Management of Dysphagia After Lung Resection: A Randomized Controlled Trial. Ann Thorac Surg 2019; 108:1059-1064. [PMID: 31194943 DOI: 10.1016/j.athoracsur.2019.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aspiration resulting from oropharyngeal dysphagia has been recognized as a serious complication after lung resection. The primary aim of this study was to determine whether early detection of postoperative dysphagia would reduce pneumonia among these patients. The median length of hospital stay was assessed. METHODS In this single-center, randomized controlled trial, the experimental group underwent clinical assessment of dysphagia before the initiation of oral intake after surgery. Therapeutic interventions were implemented immediately for patients diagnosed with dysphagia. The risk of pneumonia and the median length of hospital stay were compared between the 2 groups. RESULTS Between February 2014 and May 2016, 438 patients were randomized. Complete data from all randomized patients were analyzed. Eight cases out of 219 (3.7%) with postoperative dysphagia were detected in the experimental group. Pneumonia occurred in 14 cases out of 219 (6.4 %) in the experimental group and in 27 cases out of 219 (12.3 %) in the control group. The resulting risk reduction for pneumonia was 5.9% in the experimental group (95% confidence interval, 0.44-11.56; P = .033). The median length of hospital stay was 6 (5-8 [25th-75th percentile]) days in the experimental group and 7 (5-10 [25th-75th percentile]) days in the control group (P = .083). CONCLUSIONS Early detection of postoperative dysphagia can significantly decrease the risk of postoperative pneumonia in patients undergoing lung resection.
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Affiliation(s)
| | - Beatrix Hoksch
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gere Luder
- Department of Physiotherapy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ralph A Schmid
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin L Verra
- Department of Physiotherapy, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Larsen KS, Skoffer B, Gregersen Oestergaard L, Van Tulder M, Petersen AK. The effects of various respiratory physiotherapies after lung resection: a systematic review. Physiother Theory Pract 2019; 36:1201-1219. [DOI: 10.1080/09593985.2018.1564095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karoline Stentoft Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Birgit Skoffer
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Department of Public Health, Aarhus University, Aarhus N., Denmark
| | - Maurits Van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus N., Denmark
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Smelt J, Martin F, Al-Sahaf M, Simon N, King J, Veres L, Bille A, Pilling J, Routledge T, Harrison-Phipps K. Retrospective Observational Study into the Early Causes of Death Following Surgery for NSCLC. Thorac Cardiovasc Surg 2018; 68:633-638. [PMID: 30586674 DOI: 10.1055/s-0038-1676590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Respiratory failure has historically been the major cause of mortality after elective lung resections. With improved intubation using fiber-optic scopes, better preoperative respiratory risk assessment, more advanced anesthetic single lung ventilation, and minimally invasive surgical technique, this may have changed. Our objective was to assess the main causes of mortality over the past 10 years in patients undergoing elective lung surgery in a major UK center. MATERIALS AND METHODS A retrospective unit data search was made for all deaths during the 10-year period between January 2007 and December 2016 inclusive. All inpatient deaths within 30 days of an elective anatomical lung resection for lung malignancies were included. RESULTS Three-thousand three-hundred sixteen lung resections for malignancy were performed in the 10-year period. There were 44 (1.3%) deaths during this period, 27 (61.4%) after open lobectomies, 8 (18.2%) after video-assisted thoracoscopic surgery lobectomies, 5 (11.4%) after sleeve lobectomies, and 4 (9%) after pneumonectomies. Causes of death included 24 (54.5%) respiratory failure, 10 (22.7%) ischemic bowel, 4 (9%) coronary events, 2 (4.5%) strokes, 2 (4.5%) on table hemorrhage, 1 (2.3%) massive pulmonary embolus, and 1 (2.3%) postoperative hemorrhage. CONCLUSION Although respiratory failure is still a major cause of mortality in the postoperative patient, bowel ischemia has been found to be the second greatest cause of death. This study highlights the need to identify those at risk of this fatal complication during preoperative assessment and their postoperative management.
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Affiliation(s)
- Jeremy Smelt
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Fionna Martin
- Department of Geriatric and Pops Medicine, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - May Al-Sahaf
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Natalie Simon
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Juliet King
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Lukacs Veres
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - John Pilling
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Tom Routledge
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Karen Harrison-Phipps
- Department of Thoracic Surgery, Guy's and Saint Thomas' NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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Fujimoto S, Nakayama T. Effect of combination of pre- and postoperative pulmonary rehabilitation on onset of postoperative pneumonia: a retrospective cohort study based on data from the diagnosis procedure combination database in Japan. Int J Clin Oncol 2018; 24:211-221. [PMID: 30145745 DOI: 10.1007/s10147-018-1343-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND To examine the effect of rehabilitation on postoperative pulmonary complication when it is conducted in combination of both before and after lung cancer surgery, as compared with either before or after surgery and no rehabilitation. METHODS A retrospective cohort study was conducted to examine the effect of rehabilitation before and after lung cancer surgery on the causes of postoperative pneumonia. Data were collected from the diagnosis procedure combination (DPC) database. Patients admitted who received operative treatment for a new primary (ICD codes: C34) were selected. The inclusion criteria were patients who had pneumonectomy, malignant tumor surgery for the lung (thoracotomy), or thoracoscopic surgery (endoscopic; treatment code: K511-00, K513-00~03, and K514-00, 02). The exclusion criteria were patients who had a lung transplantation (treatment code: K514-03~06), suspected diagnosis, and a pneumonia within 3 months before being diagnosed as having lung cancer. Main outcome was onset of postoperative pneumonia. RESULTS Among 76,739 lung cancer patients, 15,146 who underwent lung cancer surgery were included in the analysis. In the combination of pre- and postoperative group, as compared with the preoperative [odds ratio (OR), 95% confidence interval (CI) 2.8, 1.8-4.4], postoperative (1.9, 1.6-2.3), and no rehabilitation group (2.5, 2.1-2.8), the onset of pneumonia was less frequent. CONCLUSIONS Combination of preoperative and postoperative rehabilitations significantly prevents postoperative pneumonia as compared with having preoperative, postoperative, or no rehabilitation.
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Affiliation(s)
- Shuhei Fujimoto
- Department of Health Informatics, Graduate School of Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan.
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan
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14
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Kendall F, Oliveira J, Peleteiro B, Pinho P, Bastos PT. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disabil Rehabil 2018; 40:864-882. [PMID: 28093920 DOI: 10.1080/09638288.2016.1277396] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/13/2016] [Accepted: 12/24/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE This study systematically review and meta-analyse the effectiveness of inspiratory muscle training (IMT) to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS), both in the preoperative and/or postoperative periods of cardiac, pulmonary, and abdominal surgical patients. Sensitive analysis was performed to examine which patients benefit more from IMT according to methodological features (quality of studies and sample size), patient's characteristics (pulmonary risk stratification, age, and body mass index), type of surgery, period of training, and training protocols (training doses and level of supervision). METHODS The literature search was made in the electronic databases PubMed®, EBSCO, Web of Science®, PEDro and Scopus®. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. RESULTS We included 17 randomized controlled trials in the systematic review, of which, 12 were included for the PPC meta-analysis and 11 for the LOS meta-analysis. IMT significantly reduced the risk of PPC (Risk Ratio (RR) = 0.50, 95%CI: 0.39, 0.64, I2 = 0.0%), and a decrease in LOS (Mean Difference = -1.41, 95%CI: -2.07, -0.75, I2 = 0.0%). CONCLUSION IMT is effective to reduce PPC and LOS in patients undergoing surgery. Implications for Rehabilitation Physiotherapy interventions with inspiratory muscle training (IMT) are effective to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS) after major surgery, and should start preoperatively. Rehabilitation with IMT is beneficial at all ages and risk levels, but older and high-risk patients benefit more, as well as pulmonary surgery patients. IMT is more effective if it is supervised, and prescription target at least two-week period, sessions with more than 15 minutes, with imposed load increment, and adding other exercise modes.
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Affiliation(s)
- Filipa Kendall
- a Department of Cardiothoracic Surgery , Centro Hospitalar de São João , Porto , Portugal
- b Polytechnic Health Institute of the North, CESPU, Gandra , Paredes , Portugal
- c Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal
| | - José Oliveira
- c Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal
| | - Bárbara Peleteiro
- d EPIUnit - Institute of Public Health , University of Porto , Porto , Portugal
- e Department of Clinical Epidemiology, Predictive Medicine and Public Health , Faculty of Medicine, University of Porto , Porto , Portugal
| | - Paulo Pinho
- a Department of Cardiothoracic Surgery , Centro Hospitalar de São João , Porto , Portugal
| | - Pedro Teixeira Bastos
- a Department of Cardiothoracic Surgery , Centro Hospitalar de São João , Porto , Portugal
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15
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Bertani A, Ferrari P, Terzo D, Russo E, Burgio G, De Monte L, Raffaele F, Droghetti A, Crisci R. A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy. J Thorac Dis 2018; 10:S499-S511. [PMID: 29629196 DOI: 10.21037/jtd.2018.02.55] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) lobectomy has recently been adopted as the gold standard surgical option for the treatment of early stage non-small cell lung cancer. Enhanced recovery after surgery (ERAS) is being progressively adopted in thoracic surgery to improve the postoperative outcomes. Even if the benefits of ERAS are universally accepted, to date a standardized and uniform approach has not been described in the medical literature. The Italian VATS group has recently proposed to include in the VATS lobectomy database a structured protocol for ERAS. Methods The ERAS section of the Italian VATS group is proposing a comprehensive ERAS protocol within the VATS lobectomy database, allowing the prospective collection of a dedicated set of data. Separate sections of the protocol are dedicated to different topics of ERAS. This study is specifically dedicated to the section of physiokinesis therapy. The medical literature will be extensively reviewed and a physiotherapy (PT) protocol of ERAS will be presented and discussed. A seta of structured clinical pathways will also be suggested for adoption in the VATS Group database. Discussion Pre- and post-operative adoption of an ERAS protocol in patients undergoing VATS lobectomy may promote an improved post-operative course, a shorter hospital stay and an overall more comfortable patients' experience. The mainstays of a physiokinesis therapy ERAS protocol are patients' education, constant physical and respiratory therapy sessions, and adoption of adequate devices. Although many studies have investigated the usefulness of physical and respiratory physiokinesis therapy, a comprehensive ERAS protocol for VATS lobectomy patients has not yet been described. The proposed ERAS platform, adopted by the VATS Group database, will contribute to a prospective data collection and allow a scientific analysis of the results.
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Affiliation(s)
- Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Paolo Ferrari
- Division of Thoracic Surgery, A. Businco Cancer Center, Ospedale Brotzu, Cagliari, Italy
| | - Danilo Terzo
- Rehabilitation Services, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Emanuele Russo
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Gaetano Burgio
- Department of Anesthesia and CCM, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Lavinia De Monte
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Francesco Raffaele
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | | | - Roberto Crisci
- Division of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
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16
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Glogowska O, Glogowski M, Szmit S. Intensive rehabilitation as an independent determinant of better outcome in patients with lung tumors treated by thoracic surgery. Arch Med Sci 2017; 13:1442-1448. [PMID: 29181076 PMCID: PMC5701684 DOI: 10.5114/aoms.2016.60706] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/17/2015] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The frequency of postoperative complications after thoracic surgery remains high. Rehabilitation may become a procedure characterized by a high cost-effectiveness ratio. The aim of the study was to determine the independent importance of intensive rehabilitation in patients with lung tumors treated by thoracic surgery. MATERIAL AND METHODS The prospective observational study included two groups of patients: 187 patients treated according to the historical scheme including thoracic surgery without specific exercises improving cardio-pulmonary capacity, and 215 patients treated in agreement with the innovative algorithm of perioperative intensive physiotherapy until discharge from hospital. The evaluated clinical endpoints comprised bronchoscopy for pulmonary toilet and all other possible postoperative complications. RESULTS The use of intensive physiotherapy significantly shortened the duration of hospitalization through reducing the frequencies of different postoperative complications. The specific clinical benefit was associated with a significantly lower rate of bronchoscopy performance for pulmonary toilet (16% vs. 5.6%, p = 0.0006). Multivariate regression analyses revealed intensive physiotherapy as a significant independent predictor for all postoperative complications (OR = 0.57; 95% CI: 0.323-0.988; p = 0.045) and need to perform bronchoscopy for pulmonary toilet (OR = 0.24; 95% CI: 0.11-0.51; p = 0.0002). CONCLUSIONS The study showed the strong independent positive effect of intensive rehabilitation in patients with lung tumors treated by thoracic surgery.
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Affiliation(s)
- Oliwia Glogowska
- Department of Rehabilitation, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Maciej Glogowski
- Lung and Thoracic Tumors Department, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Sebastian Szmit
- Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, Otwock, Poland
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Uda K, Matsui H, Fushimi K, Yasunaga H. Preoperative short-term plus postoperative physical therapy versus postoperative physical therapy alone for patients undergoing lung cancer surgery: retrospective analysis of a nationwide inpatient database. Eur J Cardiothorac Surg 2017; 53:336-341. [DOI: 10.1093/ejcts/ezx301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/12/2017] [Accepted: 07/24/2017] [Indexed: 11/13/2022] Open
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Kendall F, Abreu P, Pinho P, Oliveira J, Bastos P. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017. [PMID: 28623106 DOI: 10.1016/j.rppnen.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This review aims to appraise the role of physiotherapy care in patients submitted to pulmonary surgery, in preoperative, perioperative, and postoperative phases. Pulmonary surgery is the gold standard treatment for patients with lung cancer if it is completely resectable. However, the major impairments and complications induced by surgery are well known. Physiotherapy has been regularly used both in the preparation of the surgical candidates; in their functional recovery in the immediate postoperative period, and in the medium/long term but there is a lack of concise evidence-based recommendations. Therefore, the aim of this review is to appraise the literature about the role of physiotherapy interventions in patients undergoing lung surgery for lung cancer, in preoperative, perioperative, postoperative and maintenance stages, to the recovery and well-being, regardless of the extent of surgical approach. In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged.
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Affiliation(s)
- F Kendall
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal; CESPU, Polytechnic Health Institute of the North, Gandra, Portugal; CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal.
| | - P Abreu
- Department of Physiotherapy, Escola Superior Saúde Dr. Lopes Dias, Polytechnic Institute of Castelo Branco, Castelo Branco, Portugal
| | - P Pinho
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
| | - J Oliveira
- CIAFEL, Faculty of Sports, University of Porto, Porto, Portugal
| | - P Bastos
- Department of Cardio-Thoracic Surgery, Centro Hospitalar de São João, Porto, Portugal
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Esteban PA, Hernández N, Novoa NM, Varela G. Evaluating patients’ walking capacity during hospitalization for lung cancer resection†. Interact Cardiovasc Thorac Surg 2017; 25:268-271. [DOI: 10.1093/icvts/ivx100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/31/2017] [Indexed: 11/14/2022] Open
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20
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The effects of respiratory physiotherapy after lung resection: Protocol for a systematic review. Int J Surg Protoc 2017; 4:1-5. [PMID: 31851734 PMCID: PMC6913548 DOI: 10.1016/j.isjp.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022] Open
Abstract
To investigate the effects of respiratory physiotherapy after lung resection surgery on mortality rate within 30 days after surgery. Postoperative pulmonary complications within 30 days after surgery. Length of stay in hospital postoperatively.
Background The main treatment of lung cancer (stage 1 and 2) is lung resection surgery. The risk of postoperative pulmonary complications is high and therefore standard postoperative care involves respiratory physiotherapy. The purpose of this systematic review is to create an overview of the evidence on respiratory physiotherapy after lung resection surgery on mortality rate (within 30 days) and postoperative pulmonary complications. Methods and analysis The review will include randomized or quasi-randomized controlled studies investigating the effect of all types of respiratory physiotherapy on mortality and postoperative pulmonary complications after lung resection surgery. Furthermore, the effect of respiratory physiotherapy is evaluated on secondary outcomes such as length of hospital stay, lung volumes and function, and adverse events. The method of the planned review is described in this paper. The literature search will include the databases PubMed, Cochrane (Central), Embase, Cinahl and PEDro. The literature search is being performed in 2017. If meta-analyses are not undertaken, a narrative synthesis of the available data will be provided. The protocol was registered in PROSPERO on the 10th of October 2016 (registration number CRD42016048956). Ethics and dissemination Conclusion of this systematic review is expected available in the second half of 2017.
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Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rodriguez-Larrad A, Vellosillo-Ortega JM, Ruiz-Muneta C, Abecia-Inchaurregui LC, Seco J. Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy. Arch Bronconeumol 2016; 52:347-53. [PMID: 26860844 DOI: 10.1016/j.arbres.2015.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/02/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. DESIGN Quasi-experimental study. SETTING Tertiary referral academic hospital. PARTICIPANTS 208 patients undergoing lobectomy by open thoracotomy. INTERVENTIONS Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. OUTCOMES Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). RESULTS Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. CONCLUSIONS Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy.
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Affiliation(s)
| | | | - Carlos Ruiz-Muneta
- Servicio de Medicina Física, Complejo Hospitalario de Navarra, Pamplona, España
| | - Luis Carlos Abecia-Inchaurregui
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Farmacia, Universidad del País Vasco, Vitoria-Gasteiz, España
| | - Jesús Seco
- Instituto de Biomedicina (IBIOMED), Universidad de León, León, España; Investigador y profesor visitante, Universidad del País Vasco, Leioa, Vizcaya, España.
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Jeong JH, Yoo WG. Effects of pulmonary rehabilitation education for caregivers on pulmonary function and pain in patients with lung cancer following lung resection. J Phys Ther Sci 2015; 27:489-90. [PMID: 25729198 PMCID: PMC4339168 DOI: 10.1589/jpts.27.489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/02/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to evaluate the effects of a pulmonary
rehabilitation education program for caregivers on patients who underwent lung resection
surgery. [Subjects] Subjects who underwent lung resection by visual assisted thoracotomy
(VATs) were selected and divided into a control group of 19 and an experimental group of
22. [Methods] The experimental group received a pulmonary rehabilitation education program
for caregivers, while the control group received typical care for 4 weeks. This study
assessed the subjects 2 weeks (baseline) and 6 weeks after surgery (4 weeks). The forced
vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1) were measured to
evaluate pulmonary function. A visual analogue scale (VAS) was utilized to evaluate pain.
[Results] Pulmonary function (FVC and FEV1) increased more in the experimental group
compared with the control group. Furthermore, VAS scores were lower in the experimental
group compared with the control group. [Conclusion] A pulmonary rehabilitation education
program for caregivers had a positive effect on pulmonary function in patients with lung
cancer after lung resection.
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Affiliation(s)
- Jong-Hwa Jeong
- Department of Physical Therapy, The Graduate School, Inje University, Republic of Korea
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Rodriguez-Larrad A, Lascurain-Aguirrebena I, Abecia-Inchaurregui LC, Seco J. Perioperative physiotherapy in patients undergoing lung cancer resection. Interact Cardiovasc Thorac Surg 2014; 19:269-81. [DOI: 10.1093/icvts/ivu126] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Gómez MT, Jiménez MF, Aranda JL, Rodríguez M, Novoa NM, Varela G. The risk of bilobectomy compared with lobectomy: a retrospective analysis of a series of matched cases and controls. Eur J Cardiothorac Surg 2013; 46:72-5. [PMID: 24242849 DOI: 10.1093/ejcts/ezt521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Bilobectomy is considered to be a risky procedure due to space mismatch between the pleural space and the remnant lung. The objective of this study was to evaluate if postoperative complications related or not to size mismatch are more frequent after bilobectomy compared with right lobectomy cases. METHODS Retrospective case-control study on a series of matched non-small-cell lung cancer patients. Cases were patients who underwent right bilobectomy (upper and middle or lower and middle) and controls, patients who underwent right upper or lower lobectomy. Cases and controls were matched by propensity scoring according to site, age, ppoFEV1, type of postoperative management (intensive physiotherapy or not), cardiac comorbidity and pT status. We selected two primary outcomes for comparison: occurrence of any cardiorespiratory complication and occurrence of any complication related to space discrepancies. For the latter, all complicated case records were reviewed and two blinded observers agreed on the probability of each complication to be related to space discrepancies. Agreement was measured by the κ statistic. The overall odds ratio (OR) and 95% confidence interval (CI) for each outcome were calculated on 2 × 2 tables for the whole population and for cases with upper or lower resections. RESULTS The study included 689 patients: 572 right lobectomy (419 upper and 153 lower) and 117 bilobectomy cases (30 upper and middle and 87 lower and middle). The overall mortality rate of the series was 2.03% (14/689), and cardiorespiratory complications were recorded in 14.4% (99/689) and space-related complications in 19.59% (135/689) cases. Both observers agreed on space-related complications in 86% of the 135 cases (κ: 0.72). After matching, 234 cases entered the study (117 with right lobectomy, including 83 lower and 34 upper, and 117 with bilobectomy, including 87 lower and 30 upper). The prevalence of cardiorespiratory complications was higher after lower and middle lobectomy compared with lower lobectomy (P = 0.0002; OR: 7.96, 95% CI: 2.19-43.16). No differences were found in death rates or in space-related complications between groups of lobectomy and bilobectomy cases. CONCLUSIONS This study failed to demonstrate a higher space-related complication rate in bilobectomy cases but cardiorespiratory complications were statistically higher after lower and middle lobectomy compared with lower lobectomy in matched cases.
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Affiliation(s)
- María Teresa Gómez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | | | - José Luis Aranda
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - María Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria María Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
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