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Bhatia C1
1University Hospital Geneva, Respiratory Care Unit, Geneva, Switzerland
Background: Lung resection is the best curative cure for early stages of non- small cell lung cancer (NSCLC). Low peak VO2 and deconditioning are risk factors for surgery & poor preoperative performance increases the post operative complications & mortality risk. Impairment in cardiorespiratory fitness expressed as the peak oxygen uptake (VO2Peak) during cardiopulmonary exercise testing (CPET), has emerged as a valuable predictor of postoperative complications and long-term survival. According to the European Respiratory Society and the European Society of Thoracic Surgery guidelines, patients with a VO2Peak 10 ml/kg/ml are declared unfit for major surgical resection and those with a VO2Peak 14-16ml/kg/min are considered at high risk of early postoperative cardiopulmonary complications. In surgical candidates a 2-4 week waiting time from diagnosis to resection offers an opportunity for improvement in patient condition.
Purpose: In this randomized controlled trial, we hypothesized that a high- intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications.
Methods: Patients with operable lung cancer were randomly assigned to usual care (UC, N=77) or preoperative rehabilitation based on HIIT (Rehab, N=74). Maximal cardiopulmonary exercise testing(CPET) and the six-minute walk test were performed twice before surgery.
Results: During the preoperative waiting period (median 25 days), the peak oxygen consumption (peakVO2) and the six-minute walking distance increased (respectively, median +15 % [IQ 25-75%, +9 to +22%] P=0.003 and +15% [IQ25-75, +8 to +28%], P 0.001) in the Rehab group whereas VO2peak declined in the UC group (median -8% [IQ25-75, -16 to 0%], P=0.005). The primary endpoint did not differ significantly between the two groups: 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group developed at least one postoperative complication (P=0.080). Noteworthy, the incidence of pulmonary complications was lower in the Rehab compared with the UC group (23% vs 44%, P=0.018), owing to a significant reduction in atelectasis (12.2% vs 36.4%, P 0.001) and this was accompanied by a shorter length of stay in the postanesthesia care unit (median -7 hours, IQ25-75% -4 to -10).
Conclusion(s): Preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.
Implications: This study clearly demonstrated that an effective exercise program can improve the peak VO2 performance of severely deconditioned patients. The opportunity for physiotherapists to participate in the improvement of VO2 peak in the preoperative period implies huge impact on the present day management of cardiothoracic surgery. Patient care right from the preoperative period, during the postoperative phase and the into pulmonary rehabilitation for lung cancer patients certainly broadens the horizons for the rehabilitation team working in this field besides improving the quality of life of lung cancer patients.
Keywords: Exercise capacity, lung cancer, rehabilitation
Funding acknowledgements: Centre de la Recherche Clinique of the University Hospital of Geneva and the Ligue Genevoise contre le Cancer
Purpose: In this randomized controlled trial, we hypothesized that a high- intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications.
Methods: Patients with operable lung cancer were randomly assigned to usual care (UC, N=77) or preoperative rehabilitation based on HIIT (Rehab, N=74). Maximal cardiopulmonary exercise testing(CPET) and the six-minute walk test were performed twice before surgery.
Results: During the preoperative waiting period (median 25 days), the peak oxygen consumption (peakVO2) and the six-minute walking distance increased (respectively, median +15 % [IQ 25-75%, +9 to +22%] P=0.003 and +15% [IQ25-75, +8 to +28%], P 0.001) in the Rehab group whereas VO2peak declined in the UC group (median -8% [IQ25-75, -16 to 0%], P=0.005). The primary endpoint did not differ significantly between the two groups: 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group developed at least one postoperative complication (P=0.080). Noteworthy, the incidence of pulmonary complications was lower in the Rehab compared with the UC group (23% vs 44%, P=0.018), owing to a significant reduction in atelectasis (12.2% vs 36.4%, P 0.001) and this was accompanied by a shorter length of stay in the postanesthesia care unit (median -7 hours, IQ25-75% -4 to -10).
Conclusion(s): Preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.
Implications: This study clearly demonstrated that an effective exercise program can improve the peak VO2 performance of severely deconditioned patients. The opportunity for physiotherapists to participate in the improvement of VO2 peak in the preoperative period implies huge impact on the present day management of cardiothoracic surgery. Patient care right from the preoperative period, during the postoperative phase and the into pulmonary rehabilitation for lung cancer patients certainly broadens the horizons for the rehabilitation team working in this field besides improving the quality of life of lung cancer patients.
Keywords: Exercise capacity, lung cancer, rehabilitation
Funding acknowledgements: Centre de la Recherche Clinique of the University Hospital of Geneva and the Ligue Genevoise contre le Cancer
Topic: Cardiorespiratory; Cardiorespiratory
Ethics approval required: Yes
Institution: Hôpitaux Universitaires de Genève
Ethics committee: Hôpitaux Universitaires de Genève
Ethics number: ClinicalTrials.gov; No. NCT01258478
All authors, affiliations and abstracts have been published as submitted.
