Advertisement

Prehabilitation in Thoracic Surgery

  • Marc LickerEmail author
  • Ricard Navarro
Chapter
  • 219 Downloads

Abstract

Postoperative recovery can be impeded by the development of organ dysfunction and major complications that develop increasingly among patients with cardiovascular and pulmonary diseases but also among smokers and alcohol drinkers and those with nutritional defects, anemia and frail physical status. Enhancing the functional capacity of an individual before an operation to enable him or her to withstand the stress of surgery, has been coined “prehabilitation”. Preoperative exercise training is a key component of prehabilitation and has been shown to improve cardiorespiratory reserve and reduce postoperative pulmonary complications. Additional benefits may be achieved by correcting anaemia and nutritional status, improving oral hygiene and adopting a healthier life style (e.g., smoking and alcohol withdrawal, regular physical activity). Implementation of such multicomponent interventions requires a close collaboration amongst a multidisciplinary team and enables some high-risk patients previously deemed unsuitable for surgery to be optimized and undergo curative surgery.

Keywords

Exercise training Nutrition Alcohol Tobacco Frailty 

References

  1. 1.
    Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e278S–313S.PubMedGoogle Scholar
  2. 2.
    Brunelli A, Charloux A, Bolliger CT, et al. The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment in patients with lung cancer. Eur J Cardiothorac Surg. 2009;36:181–4.PubMedGoogle Scholar
  3. 3.
    Agostini P, Cieslik H, Rathinam S, Bishay E, Kalkat MS, Rajesh PB, Steyn RS, Singh S, Naidu B. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax. 2010;65:815–8.PubMedGoogle Scholar
  4. 4.
    Ellenberger C, Garofano N, Reynaud T, Triponez F, Diaper J, Bridevaux PO, Karenovics W, Licker M. Patient and procedural features predicting early and mid-term outcome after radical surgery for non-small cell lung cancer. J Thorac Dis. 2018;10:6020–9.PubMedPubMedCentralGoogle Scholar
  5. 5.
    TJP B, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD, Naidu B. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2018;55(1):91–115.Google Scholar
  6. 6.
    Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36:11–48.PubMedGoogle Scholar
  7. 7.
    Nakagawa T, Toyazaki T, Chiba N, Ueda Y, Gotoh M. Prognostic value of body mass index and change in body weight in postoperative outcomes of lung cancer surgery. Interact Cardiovasc Thorac Surg. 2016;23:560–6.PubMedGoogle Scholar
  8. 8.
    Schmidt M, Eckardt R, Scholtz K, Neuner B, von Dossow-Hanfstingl V, Sehouli J, Stief CG, Wernecke KD, Spies CD, PERATECS Group. Patient empowerment improved perioperative quality of care in cancer patients aged ≥ 65 years – a randomized controlled trial. PLoS One. 2015;10:e0137824.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Gajdos C, Hawn MT, Campagna EJ, Henderson WG, Singh JA, Houston T. Adverse effects of smoking on postoperative outcomes in cancer patients. Ann Surg Oncol. 2012;19:1430–8.PubMedGoogle Scholar
  10. 10.
    Rodriguez M, Gómez-Hernandez MT, Novoa N, Jiménez MF, Aranda JL, Varela G. Refraining from smoking shortly before lobectomy has no influence on the risk of pulmonary complications: a case-control study on a matched population. Eur J Cardiothorac Surg. 2017;51:498–503.PubMedGoogle Scholar
  11. 11.
    Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;3:CD002294.Google Scholar
  12. 12.
    Zwar NA, Mendelsohn CP, Richmond RL. Supporting smoking cessation. BMJ. 2014;348:f7535.PubMedGoogle Scholar
  13. 13.
    Masefield S, Powell P, Jiménez-Ruiz C, Hajek P, Lewis K, Andreas S, Tønnesen P, van Schayck O, Gratziou C, Dautzenberg B, Tonstad S, Hering T, Nardini S, Fletcher M. Recommendations to improve smoking cessation outcomes from people with lung conditions who smoke. ERJ Open Res. 2016;2:00009-2016.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Graf SA, Zeliadt SB, Rise PJ, Backhus LM, Zhou XH, Williams EC. Unhealthy alcohol use is associated with postoperative complications in veterans undergoing lung resection. J Thorac Dis. 2018;10:1648–56.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Oppedal K, Møller AM, Pedersen B, Tønnesen H. Preoperative alcohol cessation prior to elective surgery Cochrane. Database Syst Rev. 2012;7:CD008343.Google Scholar
  16. 16.
    Semenkovich TR, Frederiksen C, Hudson JL, Subramanian M, Kollef MH, Patterson GA, Kreisel D, Meyers BF, Kozower BD, Puri V. Postoperative pneumonia prevention in pulmonary resections: a feasibility pilot study. Ann Thorac Surg. 2018;107(1):262–70.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Pedersen PU, Larsen P, Håkonsen SJ. The effectiveness of systematic perioperative oral hygiene in reduction of postoperative respiratory tract infections after elective thoracic surgery in adults: a systematic review. JBI Database System Rev Implement Rep. 2016;14:140–73.PubMedGoogle Scholar
  18. 18.
    Ishimaru M, Matsui H, Ono S, Hagiwara Y, Morita K, Yasunaga H. Preoperative oral care and effect on postoperative complications after major cancer surgery. Br J Surg. 2018;105:1688–96.PubMedGoogle Scholar
  19. 19.
    Mulick A, Walker J, Puntis S, Burke K, Symeonides S, Gourley C, Wanat M, Frost C, Sharpe M. Does depression treatment improve the survival of depressed patients with cancer? A long-term follow-up of participants in the SMaRT Oncology-2 and 3 trials. Lancet Psychiatry. 2018;5:321–6.PubMedGoogle Scholar
  20. 20.
    Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne-Davis LM, Unsworth M, Osmer C, Johnston M. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016;2016:CD008646.Google Scholar
  21. 21.
    Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol. 2017;18:e457–71.PubMedGoogle Scholar
  22. 22.
    Dronkers JJ, Chorus AM, van Meeteren NL, Hopman-Rock M. The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia. 2013;68:67–73.PubMedGoogle Scholar
  23. 23.
    Struthers R, Erasmus P, Holmes K, Warman P, Collingwood A, Sneyd JR. Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients. Br J Anaesth. 2008;101:774–80.PubMedGoogle Scholar
  24. 24.
    Guazzi M, Bandera F, Ozemek C, Systrom D, Arena R. Cardiopulmonary exercise testing. what is its value?J Am Coll Cardiol. 2017;70:1618–36.Google Scholar
  25. 25.
    Shem Tov L, Matot I. Frailty and anesthesia. Curr Opin Anaesthesiol. 2017;30:409–17.PubMedGoogle Scholar
  26. 26.
    Ades PA, Toth MJ. Accelerated decline of aerobic fitness with healthy aging: what is the good news? Circulation. 2005;112:624–6.PubMedGoogle Scholar
  27. 27.
    Ali S, Garcia JM. Sarcopenia, cachexia and aging: diagnosis, mechanisms and therapeutic options – a mini-review. Gerontology. 2014;60:294–305.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Kohl BA, Deutschman CS. The inflammatory response to surgery and trauma. Cur Opin Crit Care. 2006;12:325–32.Google Scholar
  29. 29.
    Brandi LS, Bertolini R, Janni A, Gioia A, Angeletti CA. Energy metabolism of thoracic surgical patients in the early postoperative period. Effect of posture. Chest. 1996;109:630–7.PubMedGoogle Scholar
  30. 30.
    Beyer I, Njemini R, Bautmans I, Demanet C, Bergmann P, Mets T. Inflammation-related muscle weakness and fatigue in geriatric patients. Exp Gerontol. 2012;47:52–9.PubMedGoogle Scholar
  31. 31.
    Powers SK, Wiggs MP, Sollanek KJ, Smuder AJ. Ventilator-induced diaphragm dysfunction: cause and effect. Am J Physiol Regul Integr Comp Physiol. 2013;305:R464–77.PubMedGoogle Scholar
  32. 32.
    Bishop-Bailey D. Mechanisms governing the health and performance benefits of exercise. Br J Pharmacol. 2013;170:1153–66.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Grgic J, Mcllvenna LC, Fyfe JJ, Sabol F, Bishop DJ, Schoenfeld BJ, Pedisic Z. Does aerobic training promote the same skeletal muscle hypertrophy as resistance training? A systematic review and meta-analysis. Sports Med. 2018;49(2):233–54.Google Scholar
  34. 34.
    Drake JC, Wilson RJ, Yan Z. Molecular mechanisms for mitochondrial adaptation to exercise training in skeletal muscle. FASEB J. 2016;30:13–22.PubMedGoogle Scholar
  35. 35.
    Bowen TS, Schuler G, Adams V. Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training. J Cachexia Sarcopenia Muscle. 2015;6:197–207.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Marongiu E, Crisafulli A. Cardioprotection acquired through exercise: the role of ischemic preconditioning. Curr Cardiol Rev. 2014;10:336–48.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Sollanek KJ, Smuder AJ, Wiggs MP, Morton AB, Koch LG, Britton SL, Powers SK. Role of intrinsic aerobic capacity and ventilator-induced diaphragm dysfunction. J Appl Physiol (1985). 2015;118:849–57.Google Scholar
  38. 38.
    Mussi RK, Camargo EA, Ferreira T, De Moraes C, Delbin MA, Toro IF, Brancher S, Landucci EC, Zanesco A, Antunes E. Exercise training reduces pulmonary ischaemia-reperfusion-induced inflammatory responses. Eur Respir J. 2008;31:645–9.PubMedGoogle Scholar
  39. 39.
    Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programmes: is there an international consensus? Eur J Prev Cardiol. 2016;23:1715–33.PubMedGoogle Scholar
  40. 40.
    Garvey C, Bayles MP, Hamm LF, Hill K, Holland A, Limberg TM, Spruit MA. Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: review of selected guidelines. an official statement from the American Association of Cardiovascular and Pulmonary RehabilitationJ Cardiopulm Rehabil Prev. 2016;36:75–83.Google Scholar
  41. 41.
    Templeton R, Greenhalgh D. Preoperative rehabilitation for thoracic surgery. Curr Opin Anaesthesiol. 2018;32(1):23–8.Google Scholar
  42. 42.
    Piraux E, Caty G, Reychler G. Effects of preoperative combined aerobic and resistance exercise training in cancer patients undergoing tumour resection surgery: a systematic review of randomised trials. Surg Oncol. 2018;27(3):584–94.PubMedGoogle Scholar
  43. 43.
    Steffens D, Beckenkamp PR, Hancock M, Solomon M, Young J. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med. 2018;52:344.PubMedGoogle Scholar
  44. 44.
    Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev. 2017;6:CD012020.PubMedGoogle Scholar
  45. 45.
    Li J, Guo NN, Jin HR, Yu H, Wang P, Xu GG. Effects of exercise training on patients with lung cancer who underwent lung resection: a meta-analysis. World J Surg Oncol. 2017;15:158.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Pouwels S, Fiddelaers J, Teijink JA, Woorst JF, Siebenga J, Smeenk FW. Preoperative exercise therapy in lung surgery patients: a systematic review. Respir Med. 2015;109:1495–504.PubMedGoogle Scholar
  47. 47.
    Minnella EM, Awasthi R, Loiselle SE, Agnihotram RV, Ferri LE, Carli F. Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery: a randomized clinical trial. JAMA Surg. 2018;153(12):1081–9.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Sanchez-Lorente D, Navarro-Ripoll R, Guzman R, Moises J, Gimeno E, Boada M, Molins L. Prehabilitation in thoracic surgery. J Thorac Dis. 2018;10(Suppl 22):S2593–600.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University Hospital of Geneva and Faculty of Medicine, University of GenevaGenevaSwitzerland
  2. 2.Hospital ClínicBarcelonaSpain

Personalised recommendations