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Xu M, Yang X, Guo L. Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis. Pak J Med Sci 2024; 40:1280-1286. [PMID: 38952505 PMCID: PMC11190427 DOI: 10.12669/pjms.40.6.9259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/13/2023] [Accepted: 04/06/2024] [Indexed: 07/03/2024] Open
Abstract
Background & Objective Several studies have investigated the effectiveness of preoperative or perioperative pulmonary rehabilitation in thoracic surgery patients, but the results are inconsistent and inconclusive. This study attempts to summarize the existing data on the effect of the preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery. Methods Systematic search was done in PubMed Central, SCOPUS, EMBASE, MEDLINE, Google Scholar, and ScienceDirect for papers published until December 2022 and reporting data of postoperative complications and pulmonary health status in patients undergoing thoracic surgery and receiving preoperative or perioperative pulmonary rehabilitation nursing intervention or standard care. Meta-analysis was done by random-effects model and pooled standardised mean differences (SMD) or odds ratios (OR) along with 95% confidence intervals (CIs) were reported. Results Eighteen studies were included and analysed. Pooled SMD was 0.44 (95%CI: -0.21 to 1.08) for forced expiratory volume (FEV-1), -0.34 (95%CI: -0.94 to 0.26) for peak expiratory flow (PEF), 0.61 (95%CI: -0.60 to 1.81) for forced vital capacity (FVC), 0.42 (95%CI: -0.13 to 0.98) for diffusing capacity of carbon monoxide (DLCO). Pooled SMD for length of hospital stay was -0.64 (95%CI: -1.09 to -0.19). Pooled OR was 0.87 [95%CI: 0.32 to 2.37] for all-cause mortality, 0.35 [95%CI: 0.25 to 0.50] for postoperative pulmonary complications, 0.98 [95%CI: 0.45 to 2.12] for respiratory failure, 0.52 [95%CI: 0.38 to 0.78] for pneumonia and 0.50 [95%CI: 0.33 to 0.76] for atelectasis. Conclusion Perioperative pulmonary rehabilitation nursing program is effective in reducing the postoperative lung complications and shortening the length of hospital stay in patients undergoing thoracic surgery.
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Affiliation(s)
- Ming Xu
- Ming Xu, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, 507 Zhengmin Road, Shanghai 200439, P.R. China
| | - Xiaoqin Yang
- Xiaoqin Yang, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, 507 Zhengmin Road, Shanghai 200439, P.R. China
| | - Lingyan Guo
- Lingyan Guo, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, 507 Zhengmin Road, Shanghai 200439, P.R. China
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Lippi L, de Sire A, Folli A, Curci C, Calafiore D, Lombardi M, Bertolaccini L, Turco A, Ammendolia A, Fusco N, Spaggiari L, Invernizzi M. Comprehensive Pulmonary Rehabilitation for Patients with Malignant Pleural Mesothelioma: A Feasibility Pilot Study. Cancers (Basel) 2024; 16:2023. [PMID: 38893142 PMCID: PMC11171244 DOI: 10.3390/cancers16112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Malignant pleural mesothelioma (MPM) represents a significant health burden, with limited treatment options and poor prognosis. Despite advances in pharmacological and surgical interventions, the role of rehabilitation in MPM management remains underexplored. This study aims to assess the feasibility of a tailored pulmonary rehabilitation intervention addressing physical and respiratory function in MPM patients. A prospective pilot study was conducted on surgically treated MPM patients referred to a cardiopulmonary rehabilitation service. The intervention comprised multidisciplinary educational sessions, physical rehabilitation, and respiratory physiotherapy. Feasibility was evaluated based on dropout rates, adherence to the rehabilitation program, safety, and patient-reported outcomes. Twelve patients were initially enrolled, with seven completing the study. High adherence to physical (T1: 93.43%, T2: 82.56%) and respiratory (T1: 96.2%, T2: 92.5%) rehabilitation was observed, with minimal adverse events reported. Patient satisfaction remained high throughout the study (GPE scores at T1: 1.83 ± 1.17; T2: 2.0 ± 1.15), with improvements noted in physical function, pain management, and health-related quality of life. However, some issues, such as time constraints and lack of continuous supervision, were reported by participants. This pilot study demonstrates the feasibility and potential benefits of a tailored pulmonary rehabilitation intervention in MPM patients. Despite its promising outcomes, further research with larger samples is warranted to validate its efficacy and integrate rehabilitation as a component into the multidisciplinary management of MPM.
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Affiliation(s)
- Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, 1085 Budapest, Hungary;
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.F.); (A.T.); (M.I.)
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy; (C.C.); (D.C.)
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy; (C.C.); (D.C.)
| | - Mariano Lombardi
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (M.L.); (N.F.); (L.S.)
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy;
| | - Alessio Turco
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.F.); (A.T.); (M.I.)
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Fusco
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (M.L.); (N.F.); (L.S.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20122 Milan, Italy
| | - Lorenzo Spaggiari
- Division of Pathology, IEO European Institute of Oncology IRCCS, 20139 Milan, Italy; (M.L.); (N.F.); (L.S.)
- Department of Oncology and Hematology-Oncology, University of Milan, 20122 Milan, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (A.F.); (A.T.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Pompili C, Tariq J, Dalmia S, Harle A, Gilbert A, Valuckiene L, Brunelli A. Cohort study investigating evolution and factors associated with dyspnoea after anatomic lung resection. J Thorac Dis 2024; 16:113-122. [PMID: 38410604 PMCID: PMC10894400 DOI: 10.21037/jtd-23-835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/24/2023] [Indexed: 02/28/2024]
Abstract
Background Dyspnoea is common following surgical resection for non-small cell lung cancer (NSCLC). The effects range from reduced quality of life to impact on adjuvant therapy outcomes. Currently, dyspnoea beyond the immediate postoperative phase and risk factors are not well characterised. We hope to assess the evolution of patient-reported dyspnoea after anatomic lung resection and associated factors. Methods Single-centre cohort study with analysis on data collected longitudinally of 131 patients undergoing anatomic lung resections for NSCLC between September 2014 and December 2018. The European Organization for Research and Treatment Lung Cancer-specific Quality of Life Questionnaire Dyspnoea Scale was used to measure dyspnoea before and after surgery. Multivariable regression analysis was used to identify factors associated with clinically meaningful perioperative changes in dyspnoea at 6-12 months. Results Mean Dyspnoea Scale scores preoperatively and 6-12 months after resection were 12.6 (standard deviation 17.4) and 17.9 (standard deviation 20.5), respectively. Of all patients 31% experienced a clinically meaningful increase in dyspnoea, defined as >10 points between Dyspnoea Scale scores preoperatively and at 6-12 months. Comparatively, 71% of patients without preoperative symptoms of dyspnoea developed a clinically meaningful increase of dyspnoea postoperatively. After adjusting the analysis for baseline factors and preoperative Dyspnoea Scale score, female sex remained the only patient factor associated with increased postoperative dyspnoea at 6-12 months after surgery (P=0.046). A total of 34% of patients reported increased dyspnoea after lobectomies and 9% after segmentectomies (P=0.014). Segmentectomy (as opposed to larger resections) was the only surgical factor associated with lower risk of increased dyspnoea (P=0.057). Conclusions A clinically meaningful increase in dyspnoea is frequent after lung resection. Postoperative evolution of dyspnoea is non-predictable using objective baseline factors highlighting the importance of patient reported symptoms and involvement in clinical consultation.
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Affiliation(s)
- Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research, St James’s University Hospital, University of Leeds, Leeds, UK
- Thoracic Surgery Unit, University Hospital, Verona, Italy
| | - Javeria Tariq
- Division of Thoracic Surgery, St James’s University Hospital, Leeds, UK
| | | | - Amelie Harle
- Department of Oncology, Poole Hospital, Dorset, UK
| | - Alexandra Gilbert
- Leeds Institute of Medical Research, St James’s University Hospital, Leeds, UK
| | - Laura Valuckiene
- Division of Thoracic Surgery, St James’s University Hospital, Leeds, UK
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Kostorz-Nosal S, Jastrzębski D, Żebrowska A, Bartoszewicz A, Ziora D. Three Weeks of Pulmonary Rehabilitation Do Not Influence Oscillometry Parameters in Postoperative Lung Cancer Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111551. [PMID: 36363507 PMCID: PMC9696075 DOI: 10.3390/medicina58111551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 01/25/2023]
Abstract
Background: Thoracic surgery is a recommended treatment option for non-small cell lung cancer patients. An important part of a patient’s therapy, which helps to prevent postoperative complications and improve quality of life, is pulmonary rehabilitation (PR). The aim of this study was to assess whether the implementation of physical activity has an influence on forced oscillation technique (FOT) values in patients after thoracic surgery due to lung cancer. Methods: In this observational study, we enrolled 54 patients after thoracic surgery due to lung cancer, 49 patients with idiopathic interstitial fibrosis (IPF), and 54 patients with chronic obstructive pulmonary disease/asthma−COPD overlap (COPD/ACO). All patients were subjected to three weeks of in-hospital PR and assessed at the baseline as well as after completing PR by FOT, spirometry, grip strength measurement, and the 6-min walk test (6MWT). Results: We observed differences between FOT values under the influence of physical activity in studied groups, mostly between patients after thoracic surgery and COPD/ACO patients; however, no significant improvement after completing PR among FOT parameters was noticed in any group of patients. Improvements in the 6MWT distance, left hand strength, and right hand strength after PR were noticed (p < 0.001, 0.002, and 0.012, respectively). Conclusions: Three weeks of pulmonary rehabilitation had no impact on FOT values in patients after thoracic surgery due to lung cancer. Instead, we observed improvements in the 6MWT distance and the strength of both hands. Similarly, no FOT changes were observed in IPF and COPD/ACO patients after completing PR.
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Affiliation(s)
- Sabina Kostorz-Nosal
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
- Correspondence:
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
| | - Aleksandra Żebrowska
- Department of Physiological and Medical Sciences, Institute of Sport Sciences, Academy of Physical Education, 40-065 Katowice, Poland
| | - Agnieszka Bartoszewicz
- Independent Public Clinical Hospital No. 1, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland
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5
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Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M, Eden M, Hayek S, Reigle B, Kerkman A, Neves R, Jablonoski K, Hacker ED, Sun V, Newman R, McDonnell KK, L'Hotta A, Schoenhals A, Dpt NLS. Systematic Review of Functional Outcomes in Cancer Rehabilitation. Arch Phys Med Rehabil 2022; 103:1807-1826. [PMID: 35104445 PMCID: PMC9339032 DOI: 10.1016/j.apmr.2022.01.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
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Affiliation(s)
- Alix Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars Sinai Cancer, Los Angeles, California, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States.
| | - Lynn H Gerber
- College of Health and Human Services, George Mason University, Fairfax County, Virginia, United States; Inova Health System, Inova Medicine Services, Falls Church, Virginia, United States
| | | | - Alicia Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, New York, United States; Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United States; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
| | - Shana Harrington
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States; Robert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
| | - Aneesha Virani
- Rehabilitation Department, Northside Hospital, Atlanta, Georgia, United States
| | - Xiaorong Hu
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United States; Rehabilitation Medicine School, Nanjing Medical University, Nanjing, China
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona, United States
| | - Samah Hayek
- Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel
| | - Beverly Reigle
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anya Kerkman
- Lincoln Cancer Rehabilitation, Lincoln, Nebraska, United States; CHI Health St Elizabeth, Lincoln, Nebraska, United States
| | - Raquel Neves
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Kathleen Jablonoski
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Eileen Danaher Hacker
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, United States
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, United States; Department of Surgery, City of Hope, Duarte, California, United States
| | - Robin Newman
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - Karen Kane McDonnell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Allison L'Hotta
- Department of Occupational Therapy, Washington University in St Louis, St Louis, Missouri, United States
| | - Alana Schoenhals
- Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, United States
| | - Nicole L Stout Dpt
- West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United States; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
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Wang L, Yu M, Ma Y, Tian R, Wang X. Effect of Pulmonary Rehabilitation on Postoperative Clinical Status in Patients with Lung Cancer and Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4133237. [PMID: 35600945 PMCID: PMC9122671 DOI: 10.1155/2022/4133237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022]
Abstract
Pulmonary rehabilitation (PR) has a curative effect in patients undergoing pneumonectomy for lung cancer. Nevertheless, the contribution of PR to the clinical status of patients with chronic obstructive pulmonary disease (COPD) undergoing lung resection has not been adequately elucidated. The aim of this systematic review of randomized and nonrandomized controlled trials was to appraise the impact of PR compared to conventional treatment based on postoperative clinical status in patients with lung cancer and COPD. Literature in English from PubMed, Cochrane Library, Science Citation Index, and Embase databases and in Chinese from the Chinese National Knowledge Infrastructure and the WANFANG Database was retrieved from inception to November 2021, employing the keywords "Pulmonary Neoplasms," "Chronic Obstructive Pulmonary Diseases," "Physical Therapy Modalities," and "pulmonary rehabilitation." Only studies that reported PR results were included. This review was registered in the International Prospective Register of Systematic Reviews (number: CRD42021224343). A total of nine controlled trials with 651 patients were included. Postoperative pulmonary complications (PPCs) were the primary outcome measure. PR decreased the risk of complications after surgery compared to regular treatment (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.12-0.37, P < 0.01). PR reduced the risk of pneumonia after surgery compared to regular treatment (OR 0.36, 95% CI 0.15-0.86, P=0.02). There was a significant difference in the postoperative length of stay (mean difference -2.13 days, 95% CI -2.65 to -1.61 days, P < 0.05). PR was an effective intervention that decreased PPCs in patients suffering from lung cancer and COPD. However, due to the limitations of the available data, the results should be interpreted with caution.
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Affiliation(s)
- Lu Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing 100010, China
| | - Mingwei Yu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing 100010, China
| | - Yunfei Ma
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing 100010, China
| | - Rong Tian
- Beijing Geriatric Hospital, No.118 Wenquan Road, Wenquan Town, Haidian District, Beijing 100095, China
| | - Xiaomin Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Back Road of Art Gallery, Dongcheng District, Beijing 100010, China
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Mao X, Ni Y, Niu Y, Jiang L. The Clinical Value of Pulmonary Rehabilitation in Reducing Postoperative Complications and Mortality of Lung Cancer Resection: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:685485. [PMID: 34646857 PMCID: PMC8503917 DOI: 10.3389/fsurg.2021.685485] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Pulmonary rehabilitation is one meaningful way of improving exercise tolerance and pulmonary function. Thus, it may reduce the postoperative complications and mortality of pulmonary resection. Hence, we refreshed the data and conducted this systemic analysis. Method: We searched Pubmed, Web of Science, and EMBASE using “lung OR pulmonary” AND “operation OR resection OR surgery” AND “rehabilitation or exercise.” The cut-off date was September 30, 2020. The publications were filtrated, and data were extracted from all selected studies by two reviewers. Review Manger 5.1 and the fixed or random regression model were used for calculating the pooled odds ratio (OR). Result: Finally, 13 publications were enrolled in this study. Among them, five publications reported mortality, nine reported postoperative complications, and seven reported postoperative pulmonary complications. The pooled OR of mortality was 1.32 [95% confidence interval (CI): 0.54–3.23] for the pulmonary rehabilitation group, the pooled OR of postoperative complications was 0.62 (95% CI: 0.49–0.79) for the pulmonary rehabilitation group, and the pooled OR of postoperative pulmonary complications was 0.39 (95% CI: 0.27–0.56) for the pulmonary rehabilitation group. Subgroup analysis revealed the perioperative pulmonary rehabilitation was the most important part. Conclusion: Pulmonary rehabilitation may not affect the mortality of pulmonary resection patients, however, it could decrease the number of postoperative complications, especially pulmonary complications. Perioperative pulmonary rehabilitation was the most important part of the program.
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Affiliation(s)
- Xiaowei Mao
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yiqian Ni
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Yanjie Niu
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
| | - Liyan Jiang
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, China
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8
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de Oliveira Vacchi C, Martha BA, Macagnan FE. Effect of inspiratory muscle training associated or not to physical rehabilitation in preoperative anatomic pulmonary resection: a systematic review and meta-analysis. Support Care Cancer 2021; 30:1079-1092. [PMID: 34417883 DOI: 10.1007/s00520-021-06467-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/24/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study is to systematically review the effect of inspiratory muscle training (IMT) associated or not with physical rehabilitation in the preoperative period of anatomical pulmonary resection. METHODS Search in the databases: MEDLINE, Cochrane CENTRAL, EMBASE, LILACS and PEDro up to November 2019. Randomized clinical trials (RCTs) were included in adults in the preoperative period of pulmonary resection. The selection of studies and data extraction was performed by two independent reviewers. The risk of bias assessed with RoB 2.0 and the quality of evidence with GRADE. PROSPERO CRD42018105859. RESULTS Six RCTs were included; patients who underwent IMT in the preoperative period showed a significant improvement in functional capacity assessed by the 6-min walk test (6WT) (MD 28,93 [IC 95% 0,28; 57,58], p = 0,04, I2 = 0%) and significantly reduced the length of hospital stay (MD -3,63 [IC 95% -4,96; -2,29], p = 0,00, I2 = 0%). There was no significant difference between groups regarding pulmonary function, in postoperative complications such as pneumonia (RR 0,56 [IC 95% 0,29; 1,10], p = 0,09, I2 = 0%), atelectasis (RR 0,81 [IC 95% 0,24; 2,69], p = 0,72, I2 = 0%), mechanical ventilation > 48 h (RR 0,43 [IC 95% 0,12; 1,58], p = 0,20, I2 = 0%), in mortality (RR 0,33 [IC 95% 0,04; 3,12], p = 0,33, I2 = 0%), and quality of life. CONCLUSION IMT associated with physical exercise in the preoperative period of pulmonary resection improves functional capacity and reduces the length of hospital stay in the postoperative period.
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Affiliation(s)
- Cindy de Oliveira Vacchi
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil.
| | - Bianca Andrade Martha
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
| | - Fabrício Edler Macagnan
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Street Sarmento Leite, 245, Porto Alegre, RS, 90050-170, Brazil
- Department of Physiotherapy, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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9
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Tenconi S, Mainini C, Rapicetta C, Braglia L, Galeone C, Cavuto S, Merlo DF, Costi S, Paci M, Fugazzaro S. Rehabilitation for lung cancer patients undergoing surgery: results of the PUREAIR randomized trial. Eur J Phys Rehabil Med 2021; 57:1002-1011. [PMID: 34042410 DOI: 10.23736/s1973-9087.21.06789-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery for Non Small Cell Lung Cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients' overall fitness. AIM To establish whether intensive pulmonary rehabilitation, preoperative and postoperative, improves exercise capacity in patients undergoing lung resection. DESIGN Single centre, unblinded, designed for superiority, 1:1 randomised controlled trial with two parallel arms. SETTING S.Maria Nuova Hospital of Reggio Emilia (Italy). POPULATION Patients referred from local lung cancer multi-disciplinary team for lung resection. METHODS Patients were randomised to either standard of care (SC) or SC + intensive perioperative pulmonary rehabilitation (SC+PR). The primary aim was to investigate the effectiveness of pulmonary rehabilitation in improving exercise capacity six months after surgery. Additionally, we wanted to investigate the same effect shortly after surgery (at one month), as well as the overall impact of rehabilitation on lung function, postoperative complications and length of stay, Quality of Life, mood disturbances and pain. Sample was sized based on the primary outcome assuming a minimal clinically significant difference of 25 metres in exercise tolerance, measured with 6 minutes walking test. RESULTS The exercise tolerance at 6 months after surgery was significantly higher in patients undertaking PR compared to SC (+48.9 metres vs -7.5 metres respectively, difference: +56.4 metres, 95% CI: 29.6 - 83.0, p<0.001) and it showed significantly lower impairment at 1 month after surgery in the intervention group (-3.0 metres vs -30.1 metres difference: +27.1 metres, 95% CI: 3.4 - 50.8, p=0.025). No other significant differences between groups were found. CONCLUSIONS Comparison between groups showed that pulmonary rehabilitation, administered pre and postoperatively, significantly improved exercise capacity at 6 months in patients undergoing lung resection; it also significantly reduced the decrease in exercise tolerance observed 1 month after surgery. CLINICAL REHABILITATION IMPACT The PUREAIR trial highlights the importance of combined pre-operative and post-operative rehabilitation in reducing physical deconditioning in lung cancer patients undergoing surgery. Comprehensive pulmonary rehabilitation improves exercise capacity at 1 and 6 months after surgery. The PUREAIR trial results increase knowledge on comprehensive rehabilitation's outcomes in the first six months after surgery.
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Affiliation(s)
- Sara Tenconi
- Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Carlotta Mainini
- Physical Medicine and Rehabilitation, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy -
| | - Cristian Rapicetta
- Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Luca Braglia
- Research and Statistic Infrastructure, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Carla Galeone
- Pulmonology, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Research and Statistic Infrastructure, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Domenico F Merlo
- Research and Statistic Infrastructure, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, Università di Modena e Reggio Emilia, Reggio Emilia, Italy.,Scientific Directorate, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimiliano Paci
- Thoracic Surgery, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
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10
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Ogura R, Iribe S, Suzuki T, Kuroda H, Sugisawa T, Okuni I, Otsuka H, Azuma Y, Iyoda A, Ebihara S. Persistence of the Postoperative Change in the Six-minute Walking Distance of Lung Cancer Patients with Chronic Obstructive Pulmonary Disease. Prog Rehabil Med 2021; 6:20210022. [PMID: 34013089 PMCID: PMC8103386 DOI: 10.2490/prm.20210022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: The aim of this prospective follow-up study was to investigate the difference before
and after surgery in the six-minute walking distance (6MD) of lung cancer patients with
chronic obstructive pulmonary disease (COPD) and to examine the long-term effect of the
change in 6MD in the early postoperative period. Methods: This was a retrospective analysis of 25 COPD patients who underwent lung cancer surgery
and perioperative rehabilitation in our department. Assessments of 6WD were carried out
preoperatively and at 1, 3, and 6 months postoperatively. The changes in 6MD at 1, 3,
and 6 months postoperatively compared with the preoperative value were designated the
1-month Δ6MD, the 3-month Δ6MD, and the 6-month Δ6MD, and the associations between them
were investigated. Results: The mean 6MD distance was 412.0±27.3 m (95% confidence interval) preoperatively,
369.0±33.8 m at 1 month, 395.6±32.2 m at 3 months, and 400.0±38.2 m at 6 months, with a
significant difference between the preoperative and 1-month values (P<0.01). There
were strong correlations between 1-month and 3-month Δ6MDs (r =0.74,
P<0.0001) and between 1-month and 6-month Δ6MDs (r =0.88,
P<0.0001). Conclusions: In lung cancer patients with COPD, the 1-month Δ6MD was strongly associated with both
the 3-month Δ6MD and the 6-month Δ6MD. These findings suggest that the decrease in
exercise tolerance of patients whose 6MD is low at 1 month postoperatively may be
prolonged, and such patients may therefore be in greater need of postoperative
outpatient rehabilitation.
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Affiliation(s)
- Ryoji Ogura
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Shunsuke Iribe
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Takahiko Suzuki
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Haruka Kuroda
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Tatsuki Sugisawa
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Ikuko Okuni
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Hajime Otsuka
- Department of Chest Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yoko Azuma
- Department of Chest Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Akira Iyoda
- Department of Chest Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Omori Medical Center, Tokyo, Japan
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11
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Wang YQ, Cao HP, Liu X, Yang Z, Yin YY, Ma RC, Xie J. Effect of breathing exercises in patients with non-small cell lung cancer receiving surgical treatment: A randomized controlled trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Lee AHY, Snowden CP, Hopkinson NS, Pattinson KTS. Pre-operative optimisation for chronic obstructive pulmonary disease: a narrative review. Anaesthesia 2020; 76:681-694. [PMID: 32710678 DOI: 10.1111/anae.15187] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 12/26/2022]
Abstract
Chronic obstructive pulmonary disease is a condition commonly present in older people undergoing surgery and confers an increased risk of postoperative complications and mortality. Although predominantly a respiratory disease, it frequently has extra-pulmonary manifestations and typically occurs in the context of other long-term conditions. Patients experience a range of symptoms that affect their quality of life, functional ability and clinical outcomes. In this review, we discuss the evidence for techniques to optimise the care of people with chronic obstructive pulmonary disease in the peri-operative period, and address potential new interventions to improve outcomes. The article centres on pulmonary rehabilitation, widely available for the treatment of stable chronic obstructive pulmonary disease, but less often used in a peri-operative setting. Current evidence is largely at high risk of bias, however. Before surgery it is important to ensure that what have been called the 'five fundamentals' of chronic obstructive pulmonary disease treatment are achieved: smoking cessation; pulmonary rehabilitation; vaccination; self-management; and identification and optimisation of co-morbidities. Pharmacological treatment should also be optimised, and some patients may benefit from lung volume reduction surgery. Psychological and behavioural factors are important, but are currently poorly understood in the peri-operative period. Considerations of the risk and benefits of delaying surgery to ensure the recommended measures are delivered depends on patient characteristics and the nature and urgency of the planned intervention.
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Affiliation(s)
- A H Y Lee
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - C P Snowden
- Newcastle Hospitals NHS Trust, Newcastle, UK.,Newcastle University, Newcastle, UK
| | - N S Hopkinson
- National Heart and Lung Institute, Imperial College, London, UK.,The Royal Brompton Hospital, London, UK
| | - K T S Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK.,Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
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13
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Rispoli M, Salvi R, Cennamo A, Di Natale D, Natale G, Meoli I, Gioia MR, Esposito M, Nespoli MR, De Finis M, Buono S, Corcione A, Lavoretano S, Bianco A, Fiorelli A, Curcio C, Perrotta F. Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection. TUMORI JOURNAL 2020; 106:300891619900808. [PMID: 32090715 DOI: 10.1177/0300891619900808] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. METHODS This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). RESULTS All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis (n = 6), pneumonia (n = 1), respiratory failure (n = 1), and pulmonary embolism (n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor (p = 0.001). CONCLUSIONS Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.
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Affiliation(s)
- Marco Rispoli
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Rosario Salvi
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Antonio Cennamo
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Davide Di Natale
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Ilernando Meoli
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Maria Rosaria Gioia
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Marianna Esposito
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Moana Rossella Nespoli
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Mario De Finis
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Salvatore Buono
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Antonio Corcione
- Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy
| | - Sabrina Lavoretano
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Andrea Bianco
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Alfonso Fiorelli
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "L. Vanvitelli," Naples, Italy
- Thoracic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli," Naples, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
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14
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Tanaka T, Morishita S, Hashimoto M, Nakamichi T, Uchiyama Y, Hasegawa S, Domen K. Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma. Support Care Cancer 2019; 27:4107-4113. [PMID: 30788627 DOI: 10.1007/s00520-019-04704-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE According to reports, patients with lung cancer have decreased pulmonary function and exercise capacity after surgery. However, to date, physical function and health-related quality of life (HRQOL) after surgery for malignant pleural mesothelioma (MPM) have not been evaluated in detail in the convalescent phase. This study aimed to assess physical function and HRQOL of MPM patients following pleurectomy/decortication (P/D) in the convalescent phase. METHODS The study included 16 male MPM patients who underwent P/D between September 2014 and August 2016. Physical function was assessed based on handgrip and knee extensor strengths, the six-minute walk distance (6MWD), and pulmonary function, including forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). HRQOL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36). The assessment was performed preoperatively, postoperatively, and 1-year after surgery. RESULTS The 6MWD, FVC, and FEV1 values 1-year postoperatively improved significantly compared with baseline (P < 0.05 all). Additionally, the scores of six of the eight SF-36 domains were significantly improved 1 year after P/D: physical functioning, body pain, general health, vitality, social functioning, and mental health (all P < 0.05). 6MWD, FVC, and FEV1 were correlated with vitality, mental health, and physical functioning (P < 0.05 all). CONCLUSIONS Patients with MPM who underwent P/D showed improved physical function and HRQOL compared with postoperative values in the convalescent phase. Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies in the convalescent phase for such patients.
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Affiliation(s)
- Takashi Tanaka
- Department of Rehabilitation Medicine, Hyogo College of Medicine Hospital, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toru Nakamichi
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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15
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Meng S, Yang F, Dai F, Chen S, Huang C, Tan Q, Niu H. [Effect of A High Intensive Preoperative Rehabilitation on the Perioperative
Complications in Patients with Chronic Obstructive Pulmonary Disease Eligible
for Lung Cancer Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:841-848. [PMID: 30454546 PMCID: PMC6247008 DOI: 10.3779/j.issn.1009-3419.2018.11.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
背景与目的 慢性阻塞性肺病(chronic obstructive pulmonary diseases, COPD)降低患者心肺功能,可导致患者围手术期风险增加。本研究拟探讨术前短期高强度肺康复训练对肺癌合并COPD患者肺功能及术后并发症的影响。 方法 分析2016年6月-2016年12月101例肺癌合并COPD患者的临床资料,其中肺康复训练组43例,常规治疗组58例,比较两组患者肺功能、术后肺部并发症、住院时间等指标,同时比较肺康复训练组训练前后肺功能相关指标。 结果 两组患者术前一般资料及肺功能无显著差异,康复训练组住院时间更长[(17.23±4.18) d vs (14.41±4.03) d],但术后住院时间与常规治疗组无显著差异[(8.93±3.78) d vs (9.62±3.98) d],两组患者术后肺部感染[8例(18.6%) vs 17例(29.3%)]、肺不张[1例(2.3%) vs 1例(1.7%)]、呼吸衰竭[1例(2.3%) vs 2例(3.4%)]等无显著差异。肺康复训练组训练前后FEV1[(2.06±0.45) L vs (2.15±0.45) L, P < 0.001]、PEF[(4.32±0.90) L/s vs (5.15±1.05) L/s, P < 0.001]、PCO2[(42.42±2.79) mmHg vs (41.58±2.98) mmHg, P=0.009]改善明显,按亚组分析,康复训练后中-重度COPD亚组FEV1[(0.16±0.05) L (8.6%) vs (0.06±0.05) L (2.8%)]增加值较轻度COPD亚组更明显。 结论 术前短期肺康复训练可改善肺癌合并COPD患者肺功能,其中中-重度COPD患者肺功能改善更明显。
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Affiliation(s)
- Shenglan Meng
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Fan Yang
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Fuqiang Dai
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Shuang Chen
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Chaoqiong Huang
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Qunyou Tan
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Huijun Niu
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
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16
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Meng S, Yang F, Dai F, Chen S, Huang C, Tan Q, Niu H. [Effect of A High Intensive Preoperative Rehabilitation on the Perioperative
Complications in Patients with Chronic Obstructive Pulmonary Disease Eligible
for Lung Cancer Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:841-848. [PMID: 30454546 DOI: 10.3779/10.3779/j.issn.1009-3419.2018.11.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) will reduce the cardiopulmonary function and increase perioperative risk. The aim of this study is to investigate the effect of preoperative short-term high intensity lung rehabilitation training on lung function and postoperative complications in patients with COPD who are eligible for lung cancer surgery. METHODS We analysis of 101 patients with COPD and a diagnosis of lung cancer, with 43 patients in pulmonary rehabilitation group and 58 patients in conventional group. The pulmonary function, postoperative pulmonary complications (PPCs) and length of stay (LOS) will be compared between the two groups, the lung function will be compared before and after the rehabilitation at the same time. RESULTS There were no significant difference between the two groups in general information, lung function before surgery, postoperative pulmonary infection [8 (18.6%) vs 17 (29.3%)], atelectasis [1 (2.3%) vs 1 (1.7%)], respiratory failure [1 (2.3%) vs 2 (3.4%)] and postoperative LOS [(8.93±3.78) d vs (9.62±3.98) d, P>0.05]. In the rehabilitation group, the FEV1 [(2.06±0.45) L vs (2.15±0.45) L, P<0.001] and PEF [(4.32±0.90) L/s vs (5.15±1.05) L/s, P<0.001) were higher, and PCO2 [(42.42±2.79) mmHg vs (41.58±2.98) mmHg, P=0.009] was lower after rehabilitation, significantly. The increase value of FEV1 in moderate to severe COPD group was higher than that of the mild COPD group after the rehabilitation [(0.16±0.05) L, 8.6% vs (0.06±0.05) L, 2.8%, P<0.001). CONCLUSIONS The short-term highly-intensity lung rehabilitation can improve lung function in lung cancer patients with COPD, and the improvement of pulmonary function in moderate to severe COPD patients is more obviously.
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Affiliation(s)
- Shenglan Meng
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Fan Yang
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Fuqiang Dai
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Shuang Chen
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Chaoqiong Huang
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Qunyou Tan
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
| | - Huijun Niu
- The Third Affiliated Hospital of Army Medical University (Research Institute of Surgery), Chongqing 400042, China
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17
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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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18
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Tanaka T, Morishita S, Hashimoto M, Itani Y, Mabuchi S, Kodama N, Hasegawa S, Domen K. Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma. Support Care Cancer 2017; 25:2569-2575. [DOI: 10.1007/s00520-017-3666-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
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