Comparison of Two Preoperative Inspiratory Muscle Training Programs to Prevent Pulmonary Complications in Patients Undergoing Esophagectomy: A Randomized Controlled Pilot Study

Adrichem, Edwin J. van; Meulenbroek, Renée L; Plukker, John; Groen, Henk; Weert, Ellen van

doi:10.1245/s10434-014-3612-y

Cited by 102 publications

(114 citation statements)

References 21 publications

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“…This is in line with earlier studies that show that IMT can improve inspiratory muscle strength and endurance after 2 weeks of training in patients undergoing major invasive surgery [16,38,39]. Baseline values and the average increase of 20% of MIP-max are also comparable to the results in these studies.…”

Section: Discussionsupporting

confidence: 92%

Feasibility of Exercise Training in Cancer Patients Scheduled for Elective Gastrointestinal Surgery

Valkenet¹,

Trappenburg²,

Schippers

et al. 2016

Dig Surg

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Background/Aims: This study examines the feasibility of a preoperative exercise program to improve the physical fitness of a patient before gastrointestinal surgery. Methods: An outpatient exercise program was developed to increase preoperative aerobic capacity, peripheral muscle endurance and respiratory muscle function in patients with pancreatic, liver, intestinal, gastric or esophageal cancer. During a consult at the outpatient clinic, patients were invited to participate in the exercise program when their surgery was not scheduled within 2 weeks. Results: The 115 participants followed on average 5.7 (3.5) training sessions. Adherence to the exercise program was high: 82% of the planned training sessions were attended, and no adverse events occurred. Mixed model analyses showed a significant increase of maximal inspiratory muscle strength (84.1-104.7 cm H₂O; p = 0.00) and inspiratory muscle endurance (35.0-39.5 cm H₂O; p = 0.00). No significant changes were found in aerobic capacity and peripheral muscle strength. Conclusion: This exercise program in patients awaiting oncological surgery is feasible in terms of participation and adherence. Inspiratory muscle function improved significantly as a result of inspiratory muscle training. The exercise program however failed to result in improved aerobic capacity and peripheral muscle strength, probably due to the limited number of training sessions as a result of the restricted time interval between screening and surgery.

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Section: Discussionsupporting

confidence: 92%

Feasibility of Exercise Training in Cancer Patients Scheduled for Elective Gastrointestinal Surgery

Valkenet¹,

Trappenburg²,

Schippers

et al. 2016

Dig Surg

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“…Systematic reviews of patients undergoing cardiac and upper abdominal surgery have shown that preoperative IMT can decrease the rate of postoperative pneumonia. Whether preoperative IMT is of benefit in patients undergoing oesophagectomy is unclear. The aim of this RCT was to assess the effect of a preoperative IMT programme on the rate of postoperative pneumonia in patients undergoing oesophagectomy.…”

Section: Introductionmentioning

confidence: 99%

Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer

Valkenet

Trappenburg

Ruurda

et al. 2018

British Journal of Surgery

127

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Background Up to 40 per cent of patients undergoing oesophagectomy develop pneumonia. The aim of this study was to assess whether preoperative inspiratory muscle training (IMT) reduces the rate of pneumonia after oesophagectomy. Methods Patients with oesophageal cancer were randomized to a home‐based IMT programme before surgery or usual care. IMT included the use of a flow‐resistive inspiratory loading device, and patients were instructed to train twice a day at high intensity (more than 60 per cent of maximum inspiratory muscle strength) for 2 weeks or longer until surgery. The primary outcome was postoperative pneumonia; secondary outcomes were inspiratory muscle function, lung function, postoperative complications, duration of mechanical ventilation, length of hospital stay and physical functioning. Results Postoperative pneumonia was diagnosed in 47 (39·2 per cent) of 120 patients in the IMT group and in 43 (35·5 per cent) of 121 patients in the control group (relative risk 1·10, 95 per cent c.i. 0·79 to 1·53; P = 0·561). There was no statistically significant difference in postoperative outcomes between the groups. Mean(s.d.) maximal inspiratory muscle strength increased from 76·2(26·4) to 89·0(29·4) cmH2O (P < 0·001) in the intervention group and from 74·0(30·2) to 80·0(30·1) cmH2O in the control group (P < 0·001). Preoperative inspiratory muscle endurance increased from 4 min 14 s to 7 min 17 s in the intervention group (P < 0·001) and from 4 min 20 s to 5 min 5 s in the control group (P = 0·007). The increases were highest in the intervention group (P < 0·050). Conclusion Despite an increase in preoperative inspiratory muscle function, home‐based preoperative IMT did not lead to a decreased rate of pneumonia after oesophagectomy. Registration number: NCT01893008 (https://www.clinicaltrials.gov).

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“…Pulmonary complications can be reduced by minimally invasive surgery, thoracic epidural analgesia, and early enteral nutrition . Other strategies to improve preoperative condition of the patient include physical therapy to increase cardiorespiratory function . A systematic review including 12 studies evaluating the effects of preoperative exercise therapy on postoperative complication rate and length of hospital stay concluded that preoperative exercise therapy can be effective for reducing postoperative complication rates and length of hospital stay after cardiac or abdominal surgery .…”

Section: Patient Selection For Surgerymentioning

confidence: 99%

Surgical treatment of esophageal cancer in the era of multimodality management

Borggreve

Kingma

Домрачев

et al. 2018

Annals of the New York Academy of Sciences

111

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Over the last decades, the treatment of resectable esophageal cancer has evolved into a multidisciplinary process in which all players are essential for treatment to be successful. Medical oncologists and radiation oncologists have been increasingly involved since the implementation of neoadjuvant therapy, which has been shown to improve survival. Although esophagectomy is still considered the cornerstone of curative treatment for locally advanced esophageal cancer, it remains associated with considerable postoperative morbidity, despite promising results of minimally invasive techniques. In this light, both physical status and response to neoadjuvant therapy may be important factors for selecting patients who will benefit from surgery. Furthermore, it is important to optimize the entire perioperative trajectory: from the initial outpatient clinic visit to postoperative discharge. Enhanced recovery after surgery is increasingly recognized for esophagectomy and emphasizes perioperative aspects, such as nutrition, physiotherapy, and pain management. To date, several facets of esophageal cancer treatment remain topics of debate, such as the preferred neoadjuvant treatment, anastomotic technique, extent of lymphadenectomy, organization of postoperative care, and the role of surgery beyond locally advanced disease. Here, we describe the current and future perspectives in the surgical treatment of patients with esophageal cancer in the context of the available literature.

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Comparison of Two Preoperative Inspiratory Muscle Training Programs to Prevent Pulmonary Complications in Patients Undergoing Esophagectomy: A Randomized Controlled Pilot Study

Abstract: Preoperative IMT-HI showed to be a promising, effective, and feasible intervention to reduce PPCs in EC patients undergoing esophagectomy. Further research with a larger sample size is recommended.

Cited by 102 publications

References 21 publications

Feasibility of Exercise Training in Cancer Patients Scheduled for Elective Gastrointestinal Surgery

Feasibility of Exercise Training in Cancer Patients Scheduled for Elective Gastrointestinal Surgery

Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer

Surgical treatment of esophageal cancer in the era of multimodality management

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