Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Wei-Hao Chao; Sheng-Hui Tuan; En-Kuei Tang; Yi-Ju Tsai; Jing-Hui Chung; Guan-Bo Chen; Ko-Long Lin

doi:10.3389/fmed.2022.900165

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Front Med (Lausanne). 2022 Jun 15:9:900165. doi: 10.3389/fmed.2022.900165. eCollection 2022.

Authors

Wei-Hao Chao^{1

2}, Sheng-Hui Tuan^{3

4}, En-Kuei Tang^{5

6}, Yi-Ju Tsai^{2

7}, Jing-Hui Chung⁸, Guan-Bo Chen⁹, Ko-Long Lin^{8

10

11

12}

Affiliations

¹ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
² Department of Medical Education and Research, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan.
³ Institute of Allied Health Sciences, National Cheng Kung University, Tainan City, Taiwan.
⁴ Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City, Taiwan.
⁵ Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
⁶ Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan.
⁷ Department of Physical Therapy, National Cheng Kung University, Tainan City, Taiwan.
⁸ Department of Physical Medicine and Rehabilitation, Kaohsiung Veteran General Hospital, Kaohsiung City, Taiwan.
⁹ Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan.
¹⁰ School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
¹¹ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
¹² Department of Post-Baccalaureate Medicine, National Sun Yat-Sun University, Kaohsiung City, Taiwan.

Abstract

Objectives: Patients with lung cancer pose a high risk of morbidity and mortality after lung resection. Those who receive perioperative cardiopulmonary rehabilitation (PRCR) have better prognosis. Peak oxygen consumption (peak VO₂), VO₂ at the ventilatory threshold (VO₂ at VT), and slope of minute ventilation to carbon dioxide production (V_E/V_CO2 slope) measured during pre-surgical cardiopulmonary exercise testing (CPET) have prognostic values after lung resection. We aimed to investigate the influence of individualized PRCR on postoperative complications in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer with different pre-surgical risks.

Methods: This was a retrospective study. We recruited 125 patients who underwent VATS for lung cancer between 2017 and 2021. CPET was administered before surgery to evaluate the risk level and PRCR was performed based on the individual risk level defined by peak VO2, VO2 at VT, and VE/VCO2 slope, respectively. The primary outcomes were intensive care unit (ICU) and hospital lengths of stay, endotracheal intubation time (ETT), and chest tube insertion time (CTT). The secondary outcomes were postoperative complications (PPCs), including subcutaneous emphysema, pneumothorax, pleural effusion, atelectasis, infection, and empyema.

Results: Three intergroup comparisons based on the risk level by peak VO2 (3 groups), VO2 at VT (2 groups), and VE/VCO2 slope (3 groups) were done. All of the comparisons showed no significant differences in both the primary and secondary outcomes (p = 0.061-0.910).

Conclusion: Patients with different risk levels showed comparable prognosis and PPCs after undergoing CPET-guided PRCR. PRCR should be encouraged in patients undergoing VATS for lung cancer.

Keywords: cardiopulmonary exercise testing; lung cancer; perioperative cardiopulmonary rehabilitation; postoperative pulmonary complications; video-assisted thoracic surgery.