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Prehabilitation in thoracic surgery.

David Sanchez-Lorente1, Ricard Navarro-Ripoll2, Rudith Guzman1

  • 1General Thoracic Surgery Department, Clinical Respiratory Institute, Hospital ClĂ­nic of Barcelona, Barcelona, Spain.

Journal of Thoracic Disease
|October 23, 2018
PubMed
Summary
This summary is machine-generated.

Prehabilitation programs, especially high-intensity interval training (HIT), show promise for improving exercise capacity and lung function in thoracic surgery patients. Further research is needed to confirm reductions in postoperative complications and mortality, particularly in patients with impaired lung function.

Keywords:
Prehabilitationenhanced recovery after surgery (ERAS)fast tracklung cancerlung resectionpreconditioningrehabilitationrespiratory physiotherapy

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Area of Science:

  • Thoracic Surgery
  • Pulmonary Rehabilitation
  • Exercise Physiology

Background:

  • Surgical resection is optimal for early non-small cell lung cancer (NSCLC), but carries risks, especially for patients with poor lung function.
  • Enhanced recovery after surgery (ERAS) programs often focus on minimally invasive techniques and post-operative rehabilitation.
  • Preoperative exercise interventions (prehabilitation) show potential but require further investigation in thoracic surgery.

Purpose of the Study:

  • To systematically review the effectiveness and safety of prehabilitation programs in thoracic surgery.
  • To identify optimal exercise types, durations, and patient groups for prehabilitation.
  • To evaluate prehabilitation's impact on exercise capacity, pulmonary function, and postoperative outcomes.

Main Methods:

  • Systematic review of existing literature on prehabilitation in thoracic surgery.
  • Analysis of exercise interventions, including high-intensity interval training (HIT), and their duration (2-6 weeks).
  • Evaluation of patient outcomes, including exercise capacity, pulmonary function, and postoperative complications/mortality.

Main Results:

  • Prehabilitation is a safe intervention with no reported side effects.
  • High-intensity interval training (HIT) for 2-6 weeks appears most effective, though heterogeneity exists.
  • Prehabilitation significantly increases exercise capacity and enhances pulmonary function.
  • A clear reduction in postoperative complications and mortality has not been definitively demonstrated.

Conclusions:

  • Prehabilitation shows potential for optimizing physical capacity before thoracic surgery, particularly for high-risk patients with impaired lung function.
  • Further high-quality randomized clinical trials are needed, focusing on COPD patients and standardized HIT protocols (2-6 weeks).
  • While safety is established, more evidence is required to confirm prehabilitation's definitive impact on reducing postoperative morbidity and mortality.