Effect of radical resection of lung cancer combined with breathing training on lung cancer patients in thoracic surgery: a meta-analysis

Abstract

Background: Its objective was to use meta-analysis (MA) to methodically assess the impact of perioperative breathing exercises on the postoperative rehabilitation of patients with lung cancer (LC) having radical resection. METHODS: PubMed, and other databases were searched for randomized controlled trials on radical resection of LC combined with perioperative respiratory training from January 1995 to January 2024. After quality assessment, MA was performed using Review Manager 5.3 software.

Results: A total of 14 studies involving 880 patients were included, of which 434 patients received perioperative breathing training (Intervention group, IG). The differences between the two groups in terms of MIP (MD = -13.31, 95% CI: [-24.43, -2.19]; Z = 2.35, P = 0.02), FVC (MD = -0.23, 95% CI = [-0.36, -0.11]; Z = 3.69, P = 0.0002), 6-minute walk test (6MWT) values (MD = 36.42, 95% CI: [4.37, 68.48]; Z = 2.23, P = 0.03), incidence of pneumonia (OR = 0.38, 95% CI = 0.20-0.72; Z = 2.95, P = 0.003), and complication rates (OR = 0.66, 95% CI = 0.46-0.94; Z = 2.29, P = 0.02) were statistically significant. However, there were no significant differences between the two groups in MEP (MD = -6.10, 95% CI: [-12.10, -0.11]; Z = 2.00, P = 0.05), FEV1 (MD = -0.25, 95% CI = [-0.58, 0.08]; Z = 1.47, P = 0.14), FEV1/FVC (MD = -3.78, 95% CI = [-7.65, 0.09]; Z = 1.91, P = 0.06), PEF (MD = -15.02, 95% CI = [-45.88, 15.83]; Z = 0.95, P = 0.34), atelectasis (OR = 0.52, 95% CI = 0.24-1.12; Z = 1.68, P = 0.09), pneumothorax (OR = 1.20, 95% CI = 0.63-2.29; Z = 0.57, P = 0.57), and mechanical ventilation incidence (OR = 0.99, 95% CI = 0.34-2.91; Z = 0.01, P = 0.99).

Conclusion: This MA demonstrates that perioperative respiratory training significantly improves MIP, FVC, and 6MWT in patients undergoing radical LC surgery, while effectively reducing the incidence of postoperative pneumonia and overall complications. However, its impact on MEP, certain pulmonary function parameters (FEV1, FEV1/FVC, PEF), and specific complications (atelectasis, pneumothorax, mechanical ventilation requirement) did not reach statistical significance. The findings support the inclusion of respiratory training in perioperative rehabilitation programs for LC patients to optimize postoperative recovery outcomes.

Keywords: Breathing training; Lung function; MA; Postoperative pulmonary complications; RMS; Radical resection of LC.

Fig. 1

Procedures for literature inclusion and exclusion

Fig. 2

Quality assessment of the included studies. (A is summary of quality assessment; B shows the quality assessment details)

Fig. 3

Comparison of MIP between the two groups

Fig. 4

Comparison of MEP between the two groups

Fig. 5

MA FOP for contrast of lung function. (A: FVC; B FEV1; C FEV1/FVC ratio; D PEF)

Fig. 6

MA FOP of exercise capacity comparison

Fig. 7

MA FOP for contrast of postoperative pulmonary complications

Fig. 8

FUP of MA for publication bias