Boujibar Fairuz, Bonnevie Tristan, Debeaumont David, Bubenheim Michael, Cuvellier Antoine, Peillon Christophe, Gravier Francis-Edouard, Baste Jean-Marc
Normandie Univ, UNIROUEN, INSERM U1096, Rouen University Hospital, Rouen, France.
Research Group on Ventilatory Handicap (GRHV), Rouen University, Rouen, France.
J Thorac Dis. 2018 Apr;10(4):2240-2248. doi: 10.21037/jtd.2018.03.161.
Thoracic surgery is currently the optimal treatment for non-small cell lung cancer (NSCLC). However, it may be responsible for numerous postoperative complications and is often used in patients with multi co morbidities. In recent years, the optimization of a patient's physical capacity before surgery has been the subject of several studies. The objective of this study was to determine whether participation in a prehabilitation program would improve outcomes after surgery and lower morbidity according to the Clavien-Dindo classification.
This retrospective cohort study was performed between 1st January 2014 and 31st January 2016 at Rouen University Hospital. All adult patients with NSCLC (IIIa or <) who had pulmonary lobectomy by minimally invasive surgery and cardiopulmonary exercise testing [CPET (VO2max ≤20 mL/min/kg)] were included.
The cohort included 38 patients. Two groups were formed: one group with prehabilitation (n=19) and one group without prehabilitation (n=19). Four patients were not included leaving 34 patients for the final analysis. Most patients with a Clavien-Dindo grade of ≤2 had received prehabilitation compared to patients who had not received prehabilitation, respectively 17/19 8/15; P=0.0252. Patients who had received prehabilitation had fewer postoperative complications than patients who had not received prehabilitation, respectively 8/19 12/15; P=0.0382.
We have shown that prehabilitation has a positive impact on the occurrence and severity of postoperative complications after pulmonary lobectomy by minimally invasive surgery. Further studies conducted in larger populations are warranted to confirm these results.
胸外科手术目前是非小细胞肺癌（NSCLC）的最佳治疗方法。然而，它可能导致众多术后并发症，且常用于患有多种合并症的患者。近年来，术前优化患者的身体机能一直是多项研究的主题。本研究的目的是根据Clavien-Dindo分类法确定参与术前康复计划是否会改善术后结果并降低发病率。
这项回顾性队列研究于2014年1月1日至2016年1月31日在鲁昂大学医院进行。纳入所有通过微创手术进行肺叶切除术且进行了心肺运动试验[CPET（最大摄氧量≤20 mL/（min·kg））]的成年NSCLC患者（Ⅲa期或更低分期）。
该队列包括38例患者。分为两组：一组接受术前康复（n = 19），一组未接受术前康复（n = 19）。4例患者未纳入，最终分析为34例患者。与未接受术前康复的患者相比，大多数Clavien-Dindo分级≤2级的患者接受了术前康复，分别为17/19和8/15；P = 0.0252。接受术前康复的患者术后并发症比未接受术前康复的患者少，分别为8/19和12/15；P = 0.0382。
我们已经表明，术前康复对微创手术肺叶切除术后并发症的发生和严重程度有积极影响。有必要在更大规模人群中进行进一步研究以证实这些结果。
