Perioperative rehabilitation approaches in those over 75 years with respiratory dysfunction from chronic obstructive...

We report two cases of perioperative rehabilitation for abdominal cancer patients aged 75 years and older with severe chronic obstructive pulmonary disease (COPD).

Case 1 was a 75-year-old man with COPD and 52-year history of smoking 30 cigarettes per day. The patient was diagnosed with gastric cancer and scheduled for laparoscopic total gastrectomy. Preoperative forced expiratory volume in 1 second (FEV1) was 0.64 L. He could walk with intermittent rest. Case 2 was an 81-year-old woman with COPD, bronchial asthma and 40-year history of smoking 20 cigarettes per day. She was diagnosed with transverse colon cancer and scheduled for laparoscopic-assisted partial transverse colectomy. Preoperative FEV1 was 0.70 L. She could walk indoors with T-cane.

All staff started performing tasks simultaneously a week before surgery. Both patients were extubated soon after surgery; they could sit and take deep breaths soon after admission to intensive care unit. They could perform stepping movements early next morning, return to the general ward in the afternoon and started gait training. Because both patients could independently perform activities of daily living, they were discharged on postoperative day 13.

Comprehensive perioperative rehabilitation appears to be effective in high-risk patients with severe COPD who need surgery for abdominal cancer.