<p>Impact of preoperative exercise therapy on surgical outcomes in lung cancer patients with or without COPD: a systematic review and meta-analysis</p>

Abstract

Objectives This meta-analysis aimed to demonstrate the impact of preoperative exercise therapy on surgical outcomes in patients with lung cancer and COPD. Pulmonary function and muscle capacity were investigated to explore their potential links with outcome improvements after exercise. Methods Articles were searched from PubMed, Embase, and the Cochrane Library with criteria of lung cancer patients with or without COPD, undergoing resection, and receiving preoperative exercise training. Key outcomes were analyzed using meta-analysis. Results Seven studies containing 404 participants were included. Patients receiving preoperative exercise training had a lower incidence of postoperative pulmonary complications (PPCs; OR 0.44, 95% CI 0.27–0.71) and shorter length of hospital stay (standardized mean difference −4.23 days, 95% CI −6.14 to −2.32 days). Exceptionally, pneumonia incidence remained unchanged. Patients with COPD could not obviously benefit from exercise training to reduce PPCs (OR 0.44, 95% CI 0.18–1.08), but still might achieve faster recovery. No significant difference in pulmonary function was observed between the two groups. However, 6MWD and VO 2 peak were significantly improved after exercise training. Conclusion Preoperative exercise training may reduce PPCs for lung cancer patients. However, for patients with COPD undergoing lung cancer resection, the role of exercise is uncertain, due to limited data, which calls for more prospective trials on this topic. Rehabilitation exercise strengthens muscle capacity, but does not improve impaired pulmonary function, which emphasizes the possible mechanism of the protocol design.

Prehabilitation Programs For Cancer Patients: A Systematic Review Of Randomized-controlled Trials

“…Our ndings of very low-quality evidence about the effects of prehabilitation programs for HRQoL align with those reported by seven systematic reviews published recently(47, 49, 54-56, 59, 60).Contradictory ndings in different HRQoL domains have been reported by other systematic reviews (46, 48, 50, 53, 58, 61). Similarly, our ndings of very low certainty in the effects of prehabilitation programs to reduce postoperative complications coincide with those of low certainty reported by Xiang Li and colleagues in 2016(57). Other systematic reviews have reported signi cant reductions in this outcome(47-49, 51-54, 58, 61, 62) A similar trend is observed in the literature about other outcome measures in this review.…”

Impact of smoking status and chronic obstructive pulmonary disease on pulmonary complications post lung cancer surgery

“…A meta-analysis performed by Li et al included three randomised controlled trials looking at PPCs in those with COPD and lung cancer. Whilst there was an overall reduction in length of stay, there was only a trend to a reduction in PPCs, that did not reach statistical significance, however numbers were small [ 51 ]. We believe it would be reasonable to recommend exercise therapy prior to surgery if this does not delay surgery.…”

The Clinical Value of Pulmonary Rehabilitation in Reducing Postoperative Complications and Mortality of Lung Cancer Resection: A Systematic Review and Meta-Analysis

“…Many studies had supported the positive roles of rehabilitation in decreasing postoperative complications and mortality, but the majority of them are based on a single center and a limited number of patients, and they thus could not avoid selection bias. The latest systemic analysis was published in 2019 and only enrolled publications before June 2017 ( 21 ). We therefore conducted this study to update the records and explore the clinical value of pulmonary rehabilitation in decreasing postoperative complications and mortality.…”

“…However, some studies only included a randomized controlled trial (RCT) for future calculation ( 22 ). In addition, the newest one was published in 2019, and it only enrolled the publications before June 2017 ( 21 ). In the last few years, some new pulmonary rehabilitation clinical trials have been reported, including some non-RCT trials.…”