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. 2017 Sep;8(5):451-460.
doi: 10.1111/1759-7714.12466. Epub 2017 Jul 11.

Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease

Hajime Saito  1 , Kazutoshi Hatakeyama  2 , Hayato Konno  1 , Toshiki Matsunaga  2 , Yoichi Shimada  3 , Yoshihiro Minamiya  1
Affiliations

Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease

Hajime Saito et al. Thorac Cancer. 2017 Sep.

Abstract

Background: Given the extent of the surgical indications for pulmonary lobectomy in breathless patients, preoperative care and evaluation of pulmonary function are increasingly necessary. The aim of this study was to assess the contribution of preoperative pulmonary rehabilitation (PR) for reducing the incidence of postoperative pulmonary complications in non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD).

Methods: The records of 116 patients with COPD, including 51 patients who received PR, were retrospectively analyzed. Pulmonary function testing, including slow vital capacity (VC) and forced expiratory volume in one second (FEV1 ), was obtained preoperatively, after PR, and at one and six months postoperatively. The recovery rate of postoperative pulmonary function was standardized for functional loss associated with the different resected lung volumes. Propensity score analysis generated matched pairs of 31 patients divided into PR and non-PR groups.

Results: The PR period was 18.7 ± 12.7 days in COPD patients. Preoperative pulmonary function was significantly improved after PR (VC 5.3%, FEV1 5.5%; P < 0.05). The FEV1 recovery rate one month after surgery was significantly better in the PR (101.6%; P < 0.001) than in the non-PR group (93.9%). In logistic regression analysis, predicted postoperative FEV1 , predicted postoperative %FEV1 , and PR were independent factors related to postoperative pulmonary complications after pulmonary lobectomy (odds ratio 18.9, 16.1, and 13.9, respectively; P < 0.05).

Conclusions: PR improved the recovery rate of pulmonary function after lobectomy in the early period, and may decrease postoperative pulmonary complications.

Keywords: Chronic obstructive pulmonary disease; lung cancer; pulmonary rehabilitation.

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Figures

Figure 1
Figure 1
Diagram of patient selection. COPD, chronic obstructive pulmonary disease; NSCLC, non‐small cell lung cancer; PR, pulmonary rehabilitation.
Figure 2
Figure 2
The percentage increase in pulmonary function (vital capacity [VC] and forced expiratory volume in one second [FEV 1]) after pulmonary rehabilitation (PR) compared to before PR. *P < 0.05 versus before PR (n = 51).
Figure 3
Figure 3
The recovery rate of (a) vital capacity (VC) and (b) forced expiratory volume in one second (FEV 1) one and six months after pulmonary lobectomy in the pulmonary rehabilitation (PR) (closed circles) and non‐PR groups (open circles). The Y‐axis shows the recovery rate as expressed by measured postoperative value/predicted postoperative value × 100 (%). Values are expressed as means ± standard deviation. *P < 0.05 versus PR.
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