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Perioperative rehabilitation in thoracic surgery: get up and go!
  1. Edward Caruana1,
  2. Michael C Steiner2
  1. 1 Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicester, UK
  2. 2 NIHR Leicester Biomedical Research Centre, Department of Respiratory Sciences, University of Leicester, Leicester, Leics, UK
  1. Correspondence to Professor Michael C Steiner, NIHR Leicester Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, University of Leicester, Leicester LE3 9QP, East Midlands, UK; ms346{at}

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Surgical excision remains the best curative-intent option for lung cancer. Despite advances in surgical techniques, including minimally invasive access and parenchymal-sparing resections, a third of patients still suffer complications after surgery.1–3 Postoperative pulmonary complications (PPCs) represent a significant proportion of this morbidity, and strategies to reduce their frequency could deliver meaningful improvement in surgical outcomes. Numerous interventions have been proposed to modify the occurrence of PPCs although measuring their effect remains challenging because reporting standards for PPCs vary across different studies.

A myriad of interventions—often bundled together as a package termed Enhanced Recovery after Thoracic Surgery (ERATS)—have also consistently shown a reduction in morbidity, hospital stay and readmissions after thoracic surgery.4 Current ERATS guidelines from the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) promote 45 individual perioperative interventions, with most receiving a ‘strong’ recommendation grade.5 It is likely that multiple components each contribute marginal gains, with cumulatively meaningful results. Adoption of all recommendations is challenging in even the best-resourced healthcare settings, but evidence suggests higher adherence with overall enhanced recovery protocols is associated with better outcomes. However, there is a paucity of data to inform the relative importance of individual elements to both patients and healthcare systems.5 6

Pulmonary rehabilitation (PR) has an established place in the management of patients with chronic respiratory disease and is demonstrated in multiple clinical trials to deliver substantial improvements in physical capacity and health status.7 PR has been adapted and tested in a number of trials (and concomitant meta-analyses) in the perioperative period for people undergoing surgery for lung …

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  • Contributors Both authors contributed equally to writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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