Preoperative exercise may curb complications after lung cancer surgery

Last Updated: 2018-02-09

By Marilynn Larkin

NEW YORK (Reuters Health) - Moderate-quality evidence shows that preoperative exercise can reduce postoperative complication rates and hospital length of stay after lung cancer surgery, authors of a systematic review say. Evidence of an effect for other cancers is low.

"Survival for patients undergoing advanced primary or recurrent cancer surgery has improved drastically in the past few years. However, the number of major postoperative complications is still high, resulting in longer hospital stays and an increase on hospital burden," Dr. Daniel Steffens of the University of Sydney in New South Wales told Reuters Health.

"In other groups of patients, preoperative exercise seems to improve postoperative outcomes," he said by email. "For this reason, we decided to investigate it further."

As reported online January 15 in the British Journal of Sports Medicine, Dr. Steffens and colleagues searched the literature for trials that assessed the effectiveness of preoperative exercise for any cancer patients. They included 17 articles reporting on 13 different trials involving a total of 806 participants and six tumor types.

Moderate-quality evidence showed that preoperative exercise halved postoperative complication rates and reduced hospital stays by a mean of about three days in patients undergoing lung surgery compared with controls, according to the authors.

Preoperative exercise was not effective in shortening hospital stays for patients with esophageal cancer, whereas individual studies in patients with oral or prostate cancer showed that preoperative exercise improved postoperative quality of life.

No effect for preoperative exercise was found in patients with colon or colorectal liver metastases, and the quality of evidence for an effect on any outcomes in patients with other types of cancer was low.

Nonetheless, Dr. Steffens said, "Clinicians should advise patients to be more active in the preoperative period, (and) patients should be more active in general. There is no evidence suggesting that exercise causes harm in the pre/postoperative period."

The team is currently investigating the association between exercise levels and postoperative outcomes in colorectal cancer patients, and have embarked on a pilot study of a preoperative exercise program for patients who will undergo gastrointestinal cancer surgery.

Dr. Hossein Borghaei, chief, Division of Thoracic Medical Oncology at Fox Chase Cancer Center in Philadelphia, commented, "I believe the authors' conclusions are an accurate reflection of the data (and agree that) new, high-quality, randomized controlled trials should be pursued to better quantify the benefits of preoperative pulmonary rehabilitation in lung cancer patients."

Dr. Borghaei told Reuters Health by email that "at least two" such trials "have been designed to answer the question definitively": the PUREAIR trial (http://bit.ly/2Bhb2LH), which will randomize early stage lung cancer patients to a mix of home-based and outpatient rehabilitation, and a study in France that will look at the effectiveness of a supervised home exercise program in helping lung cancer patients achieve specific postoperative functional targets.

"Both studies specify a combination of aerobic exercise and upper-extremity resistance training," he noted.

"The documented advantage of perioperative pulmonary rehabilitation in patients undergoing lung transplant or lung volume reduction surgery lends plausibility to the thought that a similar strategy would work for patients undergoing lung cancer resections," he observed. "In the transplant community, preoperative pulmonary rehabilitation has already become standard of care."

SOURCE: http://bit.ly/2nHjbAI

Br J Sports Med 2018.