"Liuzijue" Qigong training enhances early pulmonary function recovery after esophageal cancer surgery

Esophageal cancer surgery is associated with a high risk of postoperative pulmonary complications, particularly pneumonia. Although conventional respiratory rehabilitation strategies - such as preoperative inspiratory muscle training - have demonstrated limited efficacy, the low-intensity traditional Chinese Qigong practice "Liuzijue" (Six-Character Formula) shows promise. However, robust clinical evidence supporting its use in patients undergoing esophagectomy remains lacking.

To evaluate the effects of early postoperative "Liuzijue" training on pulmonary function and pneumonia incidence following radical esophagectomy.

This retrospective study included 306 patients who underwent esophagectomy. The control group (n = 163) received standard care, consisting of abdominal breathing, incentive spirometry, and early ambulation. The intervention group (n = 143) received the same standard care plus twice-daily "Liuzijue" training for 14 days. Primary outcomes were the incidence of pneumonia (defined by Centers for Disease Control and Prevention criteria) and changes (Δ) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and maximum voluntary ventilation (MVV) from baseline to postoperative day 14.

The "Liuzijue" intervention was associated with a significantly lower incidence of pneumonia (11.9% vs 24.5%, P = 0.005; relative risk = 0.48). Significant improvements were observed in ΔFVC (+502.1 mL vs +326.5 mL, P < 0.001), ΔFEV₁ (+701.7 mL vs +434.4 mL, P < 0.001), and ΔMVV (+19.4 L/minute vs +14.4 L/minute, P < 0.001). Absolute FEV₁ values on postoperative day 14 were higher in the intervention group (2270.8 mL vs 2066.1 mL, P = 0.021), along with significantly lower Borg dyspnea/fatigue scores (P = 0.045). No significant differences were observed in changes in diffusing capacity of the lung for carbon monoxide, total lung capacity, or 6-minute walk distance.

Early initiation of "Liuzijue" training after esophagectomy is associated with reduced pneumonia incidence and accelerated recovery of key pulmonary function parameters. These findings support the integration of "Liuzijue" into enhanced recovery after surgery protocols for esophageal cancer patients.