Advertisement

Der Chirurg

pp 1–8 | Cite as

Präkonditionierung von Lunge und Kreislauf vor viszeral- oder thoraxchirurgischen Eingriffen

  • T. MöllerEmail author
  • T. Becker
  • J.-H. Egberts
Leitthema
  • 79 Downloads

Zusammenfassung

Hintergrund

Die Einschätzung des perioperativen Risikos spielt insbesondere in Anbetracht des demographischen Wandels eine entscheidende Rolle in der chirurgischen Indikationsstellung. Auch vor diesem Hintergrund sind heute Prähabilitationskonzepte zur Senkung des postoperativen Risikos zunehmend von Bedeutung.

Ziel der Arbeit

Darstellung der aktuellen Empfehlungen zur präoperativen Diagnostik bei thoraxchirurgischen Eingriffen sowie Prähabilitationskonzepte und deren praktischer Anwendbarkeit.

Material und Methoden

Es erfolgte eine selektive Literaturübersicht durch Recherche in den elektronischen Datenbanken PubMed, Cochrane Library und ISRCTN sowie in den aktuellen Leitlinien des American College of Chest Physicians (ACCP) und der European Society of Thoracic Surgery (ESTS).

Ergebnisse

Die Präkonditionierung umfasst die konservative Therapie von Grunderkrankungen, Rauchentwöhnung und Prähabilitation. Prähabilitation ist ein immer weiter in den klinischen Alltag drängendes Konzept, wenngleich die Evidenzlage aufgrund sehr heterogener Studienlage nur eingeschränkt vorhanden ist. Insgesamt gibt es jedoch die Tendenz zu positiven Effekten auf Lebensqualität und postoperative Komplikationen sowie Rekonvaleszenz.

Diskussion

Neben der präoperativen Diagnostik zur Einschätzung des perioperativen Risikos ist auch eine effektive Präkonditionierung der Patienten erforderlich. Hierzu ist ein interdisziplinärer Ansatz unter Einbezug von Anästhesie, Pneumologie, Psychotherapie und Physiotherapie notwendig. Neben der konservativ-medikamentösen Optimierung gewinnen Prähabilitationskonzepte an Bedeutung und werden sich sicherlich im klinischen Alltag etablieren. Von chirurgischer Seite dienen minimal-invasive Zugänge und parenchymsparende Resektionen ebenfalls der Risikoreduktion.

Schlüsselwörter

Präoperative Diagnostik Thoraxchirurgie Funktionelle Operabilität Prähabilitation Perioperative Mortalität 

Preconditioning of the lungs and circulation before visceral and thoracic surgical interventions

Abstract

Background

Estimation of the perioperative risk plays a decisive role in the surgical indications, particularly in view of the demographic change. For this reason, prehabilitation concepts for reducing perioperative risk nowadays play an increasingly important role.

Objective

Presentation of the current recommendations for preoperative diagnostics in thoracic surgical interventions as well as existing prehabilitation concepts and their practical applicability.

Material and methods

A selective review of the literature was carried out by searching the electronic databases PubMed, Cochrane Library and ISRCTN, including the guidelines of the American College of Chest Physicians (ACCP) and the European Society of Thoracic Surgery (ESTS).

Results

Preconditioning includes the conservative treatment of underlying diseases, smoking cessation and prehabilitation. Prehabilitation is an increasingly pressing concept in routine clinical practice, even though the evidence is limited due to the very heterogeneous study situation. Overall, however, there is a tendency for positive effects on the quality of life and postoperative complications as well as convalescence.

Conclusion

In addition to preoperative diagnostics to assess the perioperative risk, effective preconditioning of patients is also necessary. For this an interdisciplinary approach including anesthesia, pneumology, psychotherapy and physiotherapy is necessary. In addition to the conservative medicinal optimization, prehabilitation concepts are gaining in importance and will certainly become established in routine clinical practice. From the surgical perspective, minimally invasive approaches and parenchyma-sparing resections also serve to reduce risks.

Keywords

Preoperative diagnostics Thoracic surgery Functional operability Prehabilitation Perioperative mortality 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Möller, T. Becker und J.-H. Egberts geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Barrera R, Shi W, Amar D et al (2005) Smoking and timing of cessation: Impact on pulmonary complications after thoracotomy. Chest 127:1977–1983CrossRefGoogle Scholar
  2. 2.
    Bechard D, Wetstein L (1987) Assessment of exercise oxygen consumption as preoperative criterion for lung resection. Ann Thorac Surg 44:344–349CrossRefGoogle Scholar
  3. 3.
    Berlin NL, Cutter C, Battaglia C (2015) Will preoperative smoking cessation programs generate long-term cessation? A systematic review and meta-analysis. Am J Manag Care 21:e623–e631PubMedGoogle Scholar
  4. 4.
    Berry MF, Villamizar-Ortiz NR, Tong BC et al (2010) Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. Ann Thorac Surg 89:1044CrossRefGoogle Scholar
  5. 5.
    Blank RS, Colquhoun DA, Durieux ME et al (2016) Management of one-lung ventilation: Impact of tidal volume on complications after thoracic surgery. Anesthesiology 124:1286–1295CrossRefGoogle Scholar
  6. 6.
    Brunelli A, Al Refai M, Monteverde M et al (2002) Stair climbing test predicts cardiopulmonary complications after lung resection. Chest 121:1106–1110CrossRefGoogle Scholar
  7. 7.
    Brunelli A, Charloux A, Bolliger CT et al (2009) ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J 34(1):17–41.  https://doi.org/10.1183/09031936.00184308 (Erratum in Eur. Respir. J. 34(3):782 (2009))CrossRefPubMedGoogle Scholar
  8. 8.
    Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ (2013) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e166S–e190SCrossRefGoogle Scholar
  9. 9.
    Carli F, Charlebois P, Stein B et al (2010) Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 97:1187–1197CrossRefGoogle Scholar
  10. 10.
    Colice GL, Shafazand S, Griffin JP et al (2007) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 132:161S–177SCrossRefGoogle Scholar
  11. 11.
    Devereaux PJ, Sessler DI (2015) Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med 373:2258–2269CrossRefGoogle Scholar
  12. 12.
    Dronkers J, Lamberts H, Reutelingsperger I et al (2010) Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: A randomized controlled pilot study. Clin Rehabil 24:614–622CrossRefGoogle Scholar
  13. 13.
    Dunne DFJ, Jack S, Jones RP et al (2016) Randomized clinical trial of prehabilitation before planned liver resection. Br J Surg 103:504–512CrossRefGoogle Scholar
  14. 14.
    Ferguson MK, Little L, Rizzo L et al (1988) Diffusing capacity predicts morbidity and mortality after pulmonary resection. J Thorac Cardiovasc Surg 96:894–900PubMedGoogle Scholar
  15. 15.
    Fleisher LA, Fleischmann KE, Auerbach AD et al (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 130:2215–2245CrossRefGoogle Scholar
  16. 16.
    Li C, Carli F, Lee L et al (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: A pilot study. Surg Endosc 27:1072–1082CrossRefGoogle Scholar
  17. 17.
    Licker MJ, Widikker I, Robert J et al (2006) Operative mortality and respiratory complications after lung resection for cancer: Impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg 81:1830–1837CrossRefGoogle Scholar
  18. 18.
    Lim E, Baldwin D, Beckles M et al (2010) Guidelines on the radical management of patients with lung cancer. Thorax 65:iii1–iii27PubMedGoogle Scholar
  19. 19.
    Markos J, Mullan BP, Hillman DR et al (1989) Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 139(4):902–910CrossRefGoogle Scholar
  20. 20.
    Pfirrmann D, Simon P, Mehdorn M et al (2018) Präkonditionierung vor viszeralonkologischer Operation. Chirurg 89:896–902CrossRefGoogle Scholar
  21. 21.
    Pfirrmann D, Tug S, Brosteanu O et al (2017) Internet-based perioperative exercise program in patients with Barrett’s carcinoma scheduled for esophagectomy [iPEP – study] a prospective randomized-controlled trial. BMC Cancer 17:413CrossRefGoogle Scholar
  22. 22.
    Poole P, Chong J, Cates CJ (2015) Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD001287.pub5 CrossRefPubMedGoogle Scholar
  23. 23.
    Stefanelli F, Meoli I, Cobuccio R et al (2013) High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Eur J Cardiothorac Surg 44:e260–e265CrossRefGoogle Scholar
  24. 24.
    Thomsen T, Villebro N, Møller AM (2014) Interventions for preoperative smoking cessation. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD002294.pub4 CrossRefPubMedGoogle Scholar
  25. 25.
    Valkenet K, Trappenburg JC, Gosselink R et al (2014) Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): Study protocol for a randomized controlled trial. Trials 15:144CrossRefGoogle Scholar
  26. 26.
    Varela G, Ballesteros E, Jiménez MF et al (2006) Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. Eur J Cardiothorac Surg 29:216–220CrossRefGoogle Scholar
  27. 27.
    Wiedemann K, Männle C, Layer M, Herth F (2004) Anästhesie in der Thoraxchirurgie. Anasthesiol Intensivmed Notfallmed Schmerzther 39:616–650CrossRefGoogle Scholar
  28. 28.
    Win T, Laroche CM, Groves AM et al (2004) Use of quantitative lung scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing lobectomy. Ann Thorac Surg 78:1215–1218CrossRefGoogle Scholar
  29. 29.
    Zhang R, Ferguson MK (2015) Video-assisted versus open lobectomy in patients with compromised lung function: A literature review and meta-analysis. PLoS ONE 10:e124512CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und KinderchirurgieUniversitätsklinikum Schleswig-Holstein, Campus KielKielDeutschland

Personalised recommendations