The Short-term in-hospital Pulmonary Rehabilitation versus perioperative Short-term in-hospital Chest Therapy before lung cancer resection: a randomized controlled trial

Objective: The aim of this study is to evaluate the effect of pulmonary resection and perioperative Short-term in-hospital Pulmonary Rehabilitation (SPR) versus perioperative Short-term in-hospital Chest Therapy (SCT) on the functional capacity and postoperative morbidity of patients with poor lung function.

Design: Single-blind randomized control trial.

Setting: Thoracic surgery department at “Santo Spirito” Civil Hospital – Pescara (Italy)

Participants: Patients undergoing elective lung cancer resection (N=30).

Interventions: Patients were randomly assigned to receive daily SPR (pulmonary rehabilitation, self-management and endurance training) versus daily SCT (breathing exercises). Both groups received early postoperative rehabilitation.

Outcome Measures: Pulmonary functional parameters assessed at baseline and prior to surgery (phase 1), hospital length of stay and pulmonary complications assessed after lung cancer resection (phase 2).

Results: Thirty patients were randomly assigned to the SPR arm (15) and SCT arm (15).

During phase 1 evaluation: Forced Vital Capacity (FVC) (p 0,0001); percentage of predicted FVC (p 0,0002); Forced Expiratory Volume in the first second (FEV1) (p 0,0001); percentage of predicted FEV1 (p 0,0001). Percentage of change from baseline to prior to surgery in two groups SPR: FVC (18%); percentage of predicted FVC (20%); FEV1 (29%); percentage of predicted FEV1 (25%). SCT: FVC (10%); percentage of predicted FVC (11%); FEV1 (9%); percentage of predicted FEV1 (9%).

Phase 2: the SPR group SPR group was in a favorable clinical condition compared with the SCT arm and the SPR group had a shorter length of postoperative stay (15 ± 5 vs 17 ±5, respectively).

Conclusions: Despite poor lung function, these findings suggest that a feasible perioperative SPR before lung cancer resection improves preoperative functional capacity and decreases the postoperative respiratory morbidity.