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Review
. 2019 Feb 20:11:1765-1777.
doi: 10.2147/CMAR.S186432. eCollection 2019.

Impact of preoperative exercise therapy on surgical outcomes in lung cancer patients with or without COPD: a systematic review and meta-analysis

Xiang Li  1 , Shaolei Li  1 , Shi Yan  1 , Yaqi Wang  1 , Xing Wang  1 , Alan D L Sihoe  2 , Yue Yang  1 , Nan Wu  1
Affiliations
Review

Impact of preoperative exercise therapy on surgical outcomes in lung cancer patients with or without COPD: a systematic review and meta-analysis

Xiang Li et al. Cancer Manag Res. .

Abstract

Objectives: 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.

Methods: 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.

Results: 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 VO2 peak were significantly improved after exercise training.

Conclusion: 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.

Keywords: 6MWD; COPD; VO2 peak; lung cancer; postoperative pulmonary complications; preoperative exercise.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of study selection and funnel plot of studies included. Abbreviation: RCT, randomized controlled trial.
Figure 2
Figure 2
Forest plots of comparison: intervention group vs control group in lung cancer patients undergoing resection. Note: (A) Risk of developing postoperative pulmonary complications; (B) incidence of postoperative pneumonia; (C) postoperative length of hospital stay; (D) duration of chest drainage.
Figure 3
Figure 3
Forest plots of comparison: intervention group vs control group in lung cancer patients with COPD treated with surgery. Note: (A) Risk of developing postoperative pulmonary complications; (B) postoperative length of hospital stay.
Figure 4
Figure 4
Forest plots of comparison of post-intervention pulmonary function: intervention group vs control group in lung cancer patients undergoing resection. Note: (A) FEV1; (B) FEV1%; (C) FVC%.
Figure 5
Figure 5
Forest plots of comparison: intervention group vs control group in lung cancer patients undergoing resection. Note: (A) Postintervention 6MWD (index of lower-limb muscle strength); (B) VO2 peak (reflecting physical performance); (C) Borg scores (representing dyspnea).
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