Rispoli Marco, Salvi Rosario, Cennamo Antonio, Di Natale Davide, Natale Giovanni, Meoli Ilernando, Gioia Maria Rosaria, Esposito Marianna, Nespoli Moana Rossella, De Finis Mario, Buono Salvatore, Corcione Antonio, Lavoretano Sabrina, Bianco Andrea, Fiorelli Alfonso, Curcio Carlo, Perrotta Fabio
Anesthesia and Intensive Care, Ospedale dei Colli Vincenzo Monaldi Hospital, Napoli, Italy.
Thoracic Surgery Unit, Ospedale dei Colli, Vincenzo Monaldi Hospital, Napoli, Italy.
Tumori. 2020 Feb 23:300891619900808. doi: 10.1177/0300891619900808.
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.
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 (FEV), 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).
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 FEV% 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 ( = 6), pneumonia ( = 1), respiratory failure ( = 1), and pulmonary embolism ( = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor ( = 0.001).
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.
探讨一项基于家庭的术前康复计划对改善慢性阻塞性肺疾病（COPD）患者行肺癌肺叶切除术前肺功能及手术结局的有效性。
这是一项前瞻性、观察性、单中心研究，纳入59例轻度COPD且接受肺癌肺叶切除术的患者。所有患者均参加了一项基于家庭的术前康复计划，每周至少进行3次训练，共4周。每次训练包括有氧运动和无氧运动。参与者在日记中记录运动的频率和持续时间。主要终点是评估康复计划前后肺功能的变化，包括预测术后1秒用力呼气量（PPO FEV）、6分钟步行距离测试（6MWD）、PPO一氧化碳弥散量（DLCO）%以及血气分析值。记录术后肺部并发症，并采用多变量分析确定独立的预后因素（次要终点）。
所有患者均完成了为期4周的康复计划。59例患者中有13例（22%）（A组）每周训练次数<3次（每周平均训练次数：2.3±1.3）；59例患者中有46例（78%）（B组）每周训练次数⩾3次（每周平均训练次数：3.5±1.6）。康复前后PPO FEV%和6MWD的比较显示，仅B组有显著改善。PPO DLCO%或血气分析值未见显著变化。9例患者出现术后肺部并发症，包括肺不张（=6）、肺炎（=1）、呼吸衰竭（=1）和肺栓塞（=1）。A组术后肺部并发症的发生率高于B组（6例对3例；=0.0005）。多变量分析显示，每周康复训练次数是唯一的独立预测因素（=0.001）。
我们简单且低成本的康复计划可改善轻度至中度COPD患者行肺叶切除术前的临床功能，并减少术后肺部并发症。所有患者都应积极完成每周至少3次的康复训练，以获得显著的临床益处。我们的初步结果应通过更大规模的前瞻性研究加以证实。
