Authors (including presenting author) :
Yan TCJ(1), Lin CYA(1), Lee KWS(1), Au-Yeung YWA(2), Li KK(2), Chan HYH(2), Chan CMA(1)
Affiliation :
(1)Physiotherapy Department, Queen Elizabeth Hospital, (2)Department of Cardiothoracic Surgery, Queen Elizabeth Hospital
Introduction :
Lung resection surgery was widely adopted for treating early-stage lung cancer, the most prevalent cancer in Hong Kong. Yet, stressful surgical procedure often caused significant declines in patients’ pulmonary function and exercise capacity. Poorer preoperative cardiopulmonary function was associated with higher risks of postoperative complications and mortality. Preoperative physical training aimed at enhancing functional and physiological capacity, enabling patients to withstand surgery and hasten their recovery, especially for those with borderline cardiopulmonary function. Collaboration among cardiothoracic surgeons, specialty nurses and physiotherapists was introduced in July 2023 at Queen Elizabeth Hospital, to identify high-risk patients and refer them to join a physiotherapist-supervised preoperative Pulmonary Training Program(PTP), twice-weekly for preferably 2 months, followed by postoperative rehabilitation training.
Objectives :
To evaluate the effects of preoperative PTP on pulmonary function and exercise capacity in patients undergoing lung resection surgery.
Methodology :
It was a retrospective longitudinal study. Patient records from July 2023 to December 2024 were retrieved from Clinical Management System. Primary outcomes included pulmonary function measured by forced vital capacity(FVC) and forced expiratory volume in one second(FEV1), and exercise capacity measured by 6-Minute Walk distance(6MWD). Measurements were taken at baseline, after prehabilitation phase, immediately postoperation and after rehabilitation phase.
Result & Outcome :
Fourteen patients were recruited. Mean age was 69.2±10.3 years old. Half of them were male. Patients were referred for PTP mainly due to having respiratory comorbidities(29%) or being heavy smokers(29%). Baseline mean FVC and FEV1 were 83.8%±19.2%predicted and 80.9%±22.1%predicted respectively. Mean 6MWD was 387.6m±93m. Seven patients completed the prehabilitation phase, while two of them completed both prehabilitation and rehabilitation training as of December 2024.
After prehabilitation, mean FVC and FEV1 of both patients increased by 32.2% and 26.7% respectively, exceeding the Minimal Clinical Important Difference(MCID) of FVC(2%) and FEV1(12%). Physically, mean 6MWD improved by 33m, exceeding the MCID of 6MWD(22m).
After surgery, the patients experienced declines in lung function and exercise tolerance. However, upon completing rehabilitation training, mean FVC and FEV1 of both patients returned to 128.8% and 118.9% of their baseline respectively. 6MWD also improved and returned to baseline(100.8%).
This study suggested that preoperative PTP may help optimize high-risk patients’ cardiopulmonary function before surgery and aid recovery. Further research with a larger sample size and patient-centred outcomes was warranted.
