, Volume 15, Issue 2, pp 69–74 | Cite as

Effect of early mobilization on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery on the esophagus

  • Masatoshi Hanada
  • Kengo Kanetaka
  • Shigekazu Hidaka
  • Ken Taniguchi
  • Masato Oikawa
  • Shuntaro Sato
  • Susumu Eguchi
  • Ryo Kozu
Original Article



Esophagectomy performed via thoracotomy is associated with a high rate of postoperative pulmonary complications. Video-assisted thoracoscopic surgery at the esophagus (VATS-E) can reduce the rate of postoperative pulmonary complications. VATS-E is being increasingly implemented owing to its benefits. This procedure makes early patient mobilization possible, because there is minimal thoracic wall invasion, and thus, less postoperative pain. This study aimed to identify the efficacy of early mobilization in patients undergoing VATS-E.


We retrospectively reviewed the patients who underwent VATS-E between November 2008 and October 2016. All the patients underwent preoperative physiotherapy and postoperative early mobilization for standard perioperative management. We examined the relation between early mobilization and the factors affecting postoperative pulmonary complications and the duration of physiotherapy with regard to the surgical outcome of VATS-E.


A total of 118 patients who underwent VATS-E were assessed. The incidence of postoperative pulmonary atelectasis decreased with early mobilization, and earlier mobilization was associated with a better decrease (P < 0.001). Multiple logistic regression analysis identified the percentage of volume capacity [odds ratio (OR) 0.96; 95% confidence interval (CI) 0.93–0.99] and initial walking (OR 1.82; 95% CI 1.40–2.48) as independent risk factors for postoperative pulmonary atelectasis. In addition, the presence or absence of atelectasis was found to reduce the necessary period of physiotherapy (P < 0.001).


Our results indicated that early mobilization reduces the incidence of postoperative pulmonary atelectasis, which may also contribute to early recovery in patients who undergo VATS-E.


Early mobilization Physiotherapy Thoracoscopic esophagectomy Esophageal cancer Postoperative pulmonary complications 



The authors thank all the subjects who participated in this study. The authors are grateful to the surgeons, nurses, and staff of the Department of Rehabilitation Medicine at Nagasaki University Hospital.


This study did not receive special funding.

Compliance with ethical standards

Ethical statement

The Human Ethics Review Committee of Nagasaki University Hospital (Approval number: 13093051) approved this study. This work conforms to the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning human and animal rights. Also, the authors followed the policy concerning informed consent as shown.

Conflict of interest

All the authors declare that they have no conflict of interest regarding the subject of this study.


  1. 1.
    Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002;123(4):661–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Feeney C, Hussey J, Carey M, et al. Assessment of physical fitness for esophageal surgery, and targeting interventions to optimize outcomes. Dis Esophagus. 2010;23(7):529–39.CrossRefPubMedGoogle Scholar
  3. 3.
    Taguchi S, Osugi H, Higashino M, et al. Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc. 2003;17(9):1445–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379(9829):1887–92.CrossRefPubMedGoogle Scholar
  5. 5.
    Smithers BM, Gotley DC, Martin I, et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245(2):232–40.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pasquina P, Tramèr MR, Granier JM, et al. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest. 2006;130(6):1887–99.CrossRefPubMedGoogle Scholar
  7. 7.
    Cao S, Zhao G, Cui J, et al. Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer. 2013;21(3):707–14.CrossRefPubMedGoogle Scholar
  8. 8.
    Mackay MR, Ellis E, Johnston C. Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. Aust J Physiother. 2005;51(3):151–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Hall A, Older P. Cardiopulmonary exercise testing accurately predicts risk of major surgery including esophageal resection: letter 1. Ann Thorac Surg. 2009;87(2):670–1 (author reply 671-672).CrossRefPubMedGoogle Scholar
  10. 10.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefPubMedGoogle Scholar
  11. 11.
    Inoue J, Ono R, Makiura D, et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2013;26(1):68–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol. 2013;19(34):5598–606.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Kojima S, Sakakibara H, Motani S, et al. Incidence of chronic obstructive pulmonary disease, and the relationship between age and smoking in a Japanese population. J Epidemiol. 2007;17(2):54–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Makiura D, Ono R, Inoue J, et al. Preoperative sarcopenia is a predictor of postoperative pulmonary complications in esophageal cancer following esophagectomy: a retrospective cohort study. J Geriatr Oncol. 2016;7(6):430–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Reeve JC, Nicol K, Stiller K, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Eur J Cardiothorac Surg. 2010;37(5):1158–66.CrossRefPubMedGoogle Scholar
  16. 16.
    Nomori H, Kobayashi R, Fuyuno G, et al. Preoperative respiratory muscle training. Assessment in thoracic surgery patients with special reference to postoperative pulmonary complications. Chest. 1994;105(6):1782–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015;(10):CD010356.Google Scholar

Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2017

Authors and Affiliations

  • Masatoshi Hanada
    • 1
  • Kengo Kanetaka
    • 2
  • Shigekazu Hidaka
    • 3
  • Ken Taniguchi
    • 2
  • Masato Oikawa
    • 1
    • 4
  • Shuntaro Sato
    • 5
  • Susumu Eguchi
    • 2
  • Ryo Kozu
    • 1
    • 4
  1. 1.Cardiorespiratory Division, Department of Rehabilitation MedicineNagasaki University HospitalNagasakiJapan
  2. 2.Department of SurgeryNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  3. 3.Department of Surgical OncologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  4. 4.Department of Cardiopulmonary Rehabilitation ScienceNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  5. 5.Clinical Research CenterNagasaki University HospitalNagasakiJapan

Personalised recommendations