Skip to main content
SpringerLink
Log in
Book cover

Anesthesia in Thoracic Surgery pp 33–47Cite as

Prehabilitation in Thoracic Surgery

  • Chapter
  • First Online:

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.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  11. Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database Syst Rev. 2014;3:CD002294.

    Google Scholar 

  12. Zwar NA, Mendelsohn CP, Richmond RL. Supporting smoking cessation. BMJ. 2014;348:f7535.

    PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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. 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.

    PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. 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.

    PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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. Shem Tov L, Matot I. Frailty and anesthesia. Curr Opin Anaesthesiol. 2017;30:409–17.

    PubMed  Google Scholar 

  26. Ades PA, Toth MJ. Accelerated decline of aerobic fitness with healthy aging: what is the good news? Circulation. 2005;112:624–6.

    PubMed  Google Scholar 

  27. Ali S, Garcia JM. Sarcopenia, cachexia and aging: diagnosis, mechanisms and therapeutic options – a mini-review. Gerontology. 2014;60:294–305.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Kohl BA, Deutschman CS. The inflammatory response to surgery and trauma. Cur Opin Crit Care. 2006;12:325–32.

    Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  32. Bishop-Bailey D. Mechanisms governing the health and performance benefits of exercise. Br J Pharmacol. 2013;170:1153–66.

    CAS  PubMed  PubMed Central  Google Scholar 

  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. Drake JC, Wilson RJ, Yan Z. Molecular mechanisms for mitochondrial adaptation to exercise training in skeletal muscle. FASEB J. 2016;30:13–22.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  36. Marongiu E, Crisafulli A. Cardioprotection acquired through exercise: the role of ischemic preconditioning. Curr Cardiol Rev. 2014;10:336–48.

    PubMed  PubMed Central  Google Scholar 

  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.

    CAS  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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. Templeton R, Greenhalgh D. Preoperative rehabilitation for thoracic surgery. Curr Opin Anaesthesiol. 2018;32(1):23–8.

    Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  44. Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev. 2017;6:CD012020.

    PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Marc Licker

  2. Hospital Clínic, Barcelona, Spain

    Ricard Navarro

Authors
  1. Marc Licker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ricard Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Licker .

Editor information

Editors and Affiliations

  1. Consorcio Hospital General Universitario, Valencia, Spain

    Manuel Granell Gil

  2. Istanbul Medical Faculty, Department of Anaesthesiology, Istanbul University, Istanbul, Turkey

    Mert Şentürk

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Licker, M., Navarro, R. (2020). Prehabilitation in Thoracic Surgery. In: Granell Gil, M., Şentürk, M. (eds) Anesthesia in Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-28528-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-28528-9_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28527-2

  • Online ISBN: 978-3-030-28528-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation