Preoperative high-intensity training in frail old patients undergoing pulmonary resection for NSCLC

Abstract

<jats:title>Abstract</jats:title><jats:p>Thoracic surgery remains the better therapeutic option for non-small cell lung cancer patients that are diagnosed in early stage disease. Preoperative lung function assessment includes respiratory function tests (RFT) and cardio-pulmonary exercise testing (CPET). Vo2 peak, FEV1 and DLCO as well as recognition of performance status, presence of co-morbidities, frailty indexes, and age predict the potential impact of surgical resection on patient health status and survival risk. In this study we have retrospectively assessed the benefit of a high-intensity preoperative pulmonary rehabilitation program (PRP) in 14 patients with underlying lung function impairment prior to surgery. Amongst these, three patients candidate to surgical resection exhibited severe functional impairment associated with high score of frailty according CHS and SOF index, resulting in a substantial mortality risk.</jats:p><jats:p>Our observations indicate that PRP appear to reduce the mortality and morbidity risk in frail patients with concurrent lung function impairment undergoing thoracic surgery. PRP produced improvement of VO2 peak degree and pulmonary function resulting in reduced postoperative complications in high-risk patients from our cases. Our results indicate that a preoperative training program may improve postoperative clinical outcomes in fraillung cancer patients with impaired lung function prior to surgical resection.</jats:p>

COVID-19 and the elderly: insights into pathogenesis and clinical decision-making

“…Early in-hospital pulmonary rehabilitation should be considered as a minimum of clinical stability is achieved. Prolonged physical activities in home-based settings after patients discharge would be potentially beneficial [114][115][116][117][118]. Finally, despite optimized medical treatment, some patients with end-stage COVID-19 pneumonia progress to irreversible loss of lung function [119].…”

Frailty and anesthesia &ndash; risks during and post-surgery

“… 83 In a very small cohort study of frail lung cancer patients (n=14), preoperative high-intensity training program could reduce postoperative complications. 84 In frail pretransplant patients, prehabilitation through fitness-based interventions with wearable fitness tracking devices can mitigate frailty and decrease length of hospital stay and postoperative complications. 85 More large-scale intervention studies on frailty in preoperative patients are needed to confirm its effectiveness in reducing morbidity and mortality.…”

The role of prehabilitation in frail surgical patients: A systematic review

“…Inspiratory muscle training (IMT) consists of respiratory muscle strength and endurance training, typically with a gradation of intensity, starting at 20%‐30% of maximal inspiratory pressure and progressing to 60% of maximal inspiratory pressure . In a case series by Salvi et al, 3 patients underwent a pulmonary rehabilitation program prior to thoracic surgery (lobectomy and mediastinal lymphadenectomy). The starting workload for pulmonary exercises commenced at 70% of the maximum VO2 max reached on cardiopulmonary exercise testing.…”