Templeton Richard, Greenhalgh Donna
Wythenshawe Hospital, Manchester Foundation Trust, Southmoor Road, Manchester, UK.
Curr Opin Anaesthesiol. 2019 Feb;32(1):23-28. doi: 10.1097/ACO.0000000000000668.
Lung resection provides the best outcome for patients with early stage lung cancer. However, lung cancer surgery carries a significant risk of perioperative complications. Patient risk may be reduced by addressing modifiable risk factors in the preoperative period. We review how this can be achieved through preoperative rehabilitation pathways.
Cardiorespiratory fitness is an independent predictor of survival for nonsmall cell cancer. Preoperative exercise programmes may improve cardiorespiratory reserve and reduce perioperative complications. Additional benefits may be achieved through interventions such as smoking cessation programmes, correction of anaemia, improvement of nutritional status and improved oral hygiene. These interventions may also have the additional benefit of enabling high-risk patients previously deemed unsuitable for surgery to be optimized to such a degree that they can undergo surgery. These interventions will achieve maximal benefit when delivered early in lung cancer pathways; this requires close collaboration amongst multidisciplinary teams.
Lung cancer surgery carries significant risk of postoperative pulmonary complications. Through integrating prehabilitation interventions into lung cancer pathways, there are opportunities to improve long-term outcomes for patients.
肺切除术为早期肺癌患者提供了最佳治疗效果。然而，肺癌手术存在显著的围手术期并发症风险。通过在术前处理可改变的风险因素，可降低患者风险。我们回顾如何通过术前康复途径实现这一目标。
心肺适能是非小细胞癌患者生存的独立预测因素。术前运动计划可能改善心肺储备并减少围手术期并发症。通过戒烟计划、纠正贫血、改善营养状况和加强口腔卫生等干预措施可获得额外益处。这些干预措施还可能带来额外好处，即让先前被认为不适合手术的高危患者得到优化，从而能够接受手术。当在肺癌治疗流程早期实施这些干预措施时，将实现最大效益；这需要多学科团队之间密切协作。
肺癌手术存在术后肺部并发症的重大风险。通过将术前康复干预措施纳入肺癌治疗流程，有机会改善患者的长期治疗效果。
