Li Xiang, Li Shaolei, Yan Shi, Wang Yaqi, Wang Xing, Sihoe Alan D L, Yang Yue, Wu Nan
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University Cancer Hospital and Institute, Beijing, China,
Department of Surgery, University of Hong Kong, Hong Kong.
Cancer Manag Res. 2019 Feb 20;11:1765-1777. doi: 10.2147/CMAR.S186432. eCollection 2019.
This meta-analysis aimed to demonstrate the impact of preoperative exercise therapy on surgical outcomes in patients with lung cancer and COPD. Pulmonary function and muscle capacity were investigated to explore their potential links with outcome improvements after exercise.
Articles were searched from PubMed, Embase, and the Cochrane Library with criteria of lung cancer patients with or without COPD, undergoing resection, and receiving preoperative exercise training. Key outcomes were analyzed using meta-analysis.
Seven studies containing 404 participants were included. Patients receiving preoperative exercise training had a lower incidence of postoperative pulmonary complications (PPCs; OR 0.44, 95% CI 0.27-0.71) and shorter length of hospital stay (standardized mean difference -4.23 days, 95% CI -6.14 to -2.32 days). Exceptionally, pneumonia incidence remained unchanged. Patients with COPD could not obviously benefit from exercise training to reduce PPCs (OR 0.44, 95% CI 0.18-1.08), but still might achieve faster recovery. No significant difference in pulmonary function was observed between the two groups. However, 6MWD and VO peak were significantly improved after exercise training.
Preoperative exercise training may reduce PPCs for lung cancer patients. However, for patients with COPD undergoing lung cancer resection, the role of exercise is uncertain, due to limited data, which calls for more prospective trials on this topic. Rehabilitation exercise strengthens muscle capacity, but does not improve impaired pulmonary function, which emphasizes the possible mechanism of the protocol design.
本荟萃分析旨在证明术前运动疗法对肺癌合并慢性阻塞性肺疾病（COPD）患者手术结局的影响。研究肺功能和肌肉能力，以探讨它们与运动后结局改善之间的潜在联系。
从PubMed、Embase和Cochrane图书馆检索文章，纳入标准为患有或未患有COPD的肺癌患者，接受切除术，并接受术前运动训练。使用荟萃分析对关键结局进行分析。
纳入了7项研究，共404名参与者。接受术前运动训练的患者术后肺部并发症（PPCs）发生率较低（比值比0.44，95%置信区间0.27 - 0.71），住院时间较短（标准化均差 - 4.23天，95%置信区间 - 6.14至 - 2.32天）。例外的是，肺炎发生率保持不变。COPD患者不能明显从运动训练中获益以减少PPCs（比值比0.44，95%置信区间0.18 - 1.08），但仍可能实现更快恢复。两组之间肺功能未观察到显著差异。然而，运动训练后6分钟步行距离（6MWD）和峰值摄氧量（VO₂peak）显著改善。
术前运动训练可能降低肺癌患者的PPCs。然而，对于接受肺癌切除术的COPD患者，由于数据有限，运动的作用尚不确定，这需要更多关于该主题的前瞻性试验。康复运动增强肌肉能力，但不能改善受损的肺功能，这强调了方案设计的可能机制。
