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  • Effects of enhanced recovery after surgery plus pulmonary rehabilitation on complications after video-assisted lung cancer surgery: a multicentre randomised controlled trial

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Lung cancer
Original research
Effects of enhanced recovery after surgery plus pulmonary rehabilitation on complications after video-assisted lung cancer surgery: a multicentre randomised controlled trial
  1. Yu Zheng1,
  2. Mao Mao1,
  3. Fang Li2,
  4. Lu Wang1,3,
  5. Xintong Zhang1,
  6. Xiu Zhang1,
  7. Haiming Wang4,
  8. Huiqing Zhou5,
  9. Meifang Ji6,
  10. Yulong Wang7,
  11. Liang Liu8,
  12. Quan Zhu2,
  13. Jan D Reinhardt9,10,11,12,
  14. Xiao Lu1
  1. 1 Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
  2. 2 Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
  3. 3 Department of Rehabilitation Medicine, Qingdao Municipal Hospital Group, Qingdao, Shandong, China
  4. 4 Department of Rehabilitation Medicine, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
  5. 5 Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Tai Zhou, Zhejiang, China
  6. 6 Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, Hainan, China
  7. 7 Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, China
  8. 8 Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
  9. 9 Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, Sichuan, China
  10. 10 Swiss Paraplegic Research, Nottwil, Switzerland
  11. 11 Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
  12. 12 Rehabilitation Research Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
  1. Correspondence to Dr Xiao Lu, Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; luxiao1972{at}163.com; Dr Jan D Reinhardt; reinhardt{at}scu.edu.cn; Dr Quan Zhu; zhuquan{at}njmu.edu.cn

Abstract

Background Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). We evaluated whether enhanced recovery after surgery plus pulmonary rehabilitation was superior over enhanced recovery after surgery alone in reducing the incidence of postoperative PPCs and length of hospital stay.

Methods In this pragmatic multicentre, randomised controlled, parallel-group clinical trial, eligible patients scheduled for video-assisted lung cancer surgery were randomly assigned (1:1) to either a newly developed programme that integrated preoperative and postoperative pulmonary rehabilitation components into a generic thoracic enhanced recovery after surgery pathway, or routine thoracic enhanced recovery after surgery. Primary outcome was the overall occurrence of PPCs within 2 weeks after surgery. Secondary outcomes were the occurrence of specific complications, time to removal of chest drain, and length of hospital stay (LOS).

Results Of 428 patients scheduled for lung cancer surgery, 374 were randomised with 187 allocated to the experimental programme and 187 to control. Incidence of PPCs at 14 Days was 18.7% (35/187) in the experimental group and 33.2% (62/187) in the control group (intention-to-treat, unadjusted HR 0.524, 95% CI 0.347 to 0.792, p=0.002). Particularly, significant risk reduction was observed regarding pleural effusion, pneumonia and atelectasis. Time to removal of chest drain and LOS were not significantly reduced in the experimental group.

Conclusions Adding pulmonary rehabilitation to enhanced recovery after surgery appears to be effective in reducing the incidence of PPCs, but not LOS. Standard integration of pulmonary rehabilitation into thoracic enhanced recovery after surgery is a promising approach to PPC prophylaxis.

Trial registration number ChiCTR1900024646.

  • lung cancer
  • pulmonary rehabilitation

Data availability statement

Data are available from the corresponding authors upon reasonable request.

https://doi.org/10.1136/thoraxjnl-2021-218183

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    Data availability statement

    Data are available from the corresponding authors upon reasonable request.

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    Footnotes

    • YZ, MM, FL and LW contributed equally.

    • Contributors Study design: XL, QZ and YZ. Data collection and management: MM, FL, LW, XTZ, XZ, HW, HZ, MJ, YW and LL. Data analysis: JDR, YZ and LW. Writing and editing of manuscript: All authors. Revising manuscript critically for important intellectual content: All authors. Approval of final manuscript: All authors. Guarantor: ZY and JR .

    • Funding This work was supported by the National Key Research and Development Programme of China (Grant number of 2018YFC1313600) and the Nanjing Municipal Science and Technology Bureau (Grant number of 2019060002).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.