Preoperative rehabilitation for thoracic surgery

Lung resection provides the best outcome for patients with early stage lung cancer. However, lung cancer surgery carries a significant risk of perioperative complications. Patient risk may be reduced by addressing modifiable risk factors in the preoperative period. We review how this can be achieved through preoperative rehabilitation pathways.

Cardiorespiratory fitness is an independent predictor of survival for nonsmall cell cancer. Preoperative exercise programmes may improve cardiorespiratory reserve and reduce perioperative complications. Additional benefits may be achieved through interventions such as smoking cessation programmes, correction of anaemia, improvement of nutritional status and improved oral hygiene. These interventions may also have the additional benefit of enabling high-risk patients previously deemed unsuitable for surgery to be optimized to such a degree that they can undergo surgery. These interventions will achieve maximal benefit when delivered early in lung cancer pathways; this requires close collaboration amongst multidisciplinary teams.

Lung cancer surgery carries significant risk of postoperative pulmonary complications. Through integrating prehabilitation interventions into lung cancer pathways, there are opportunities to improve long-term outcomes for patients.