Effect of prehabilitation on ventilatory efficiency in non-small cell lung cancer patients: A cohort study

Francis-Edouard Gravier; Tristan Bonnevie; Fairuz Boujibar; Clément Médrinal; Guillaume Prieur; Yann Combret; Jean-François Muir; Antoine Cuvelier; Jean-Marc Baste; David Debeaumont

doi:10.1016/j.jtcvs.2019.02.016

Effect of prehabilitation on ventilatory efficiency in non-small cell lung cancer patients: A cohort study

J Thorac Cardiovasc Surg. 2019 Jun;157(6):2504-2512.e1. doi: 10.1016/j.jtcvs.2019.02.016. Epub 2019 Feb 19.

Affiliations

¹ ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France. Electronic address: [email protected].
² ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France.
³ INSERM U1096, Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Medico-Surgical Intensive Care Unit, Jacques Monod Hospital, Le Havre, France.
⁴ UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL and Dermatologie, Université Catholique de Louvain, Brussels, Belgium.
⁵ Physiotherapy Department, Groupe Hospitalier du Havre, Montivilliers, France; Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France.
⁶ UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Medico-Surgical Intensive Care Unit, Jacques Monod Hospital, Le Havre, France.
⁷ INSERM U1096, Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Department of Thoracic Surgery, Rouen University Hospital, Rouen, France.
⁸ Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France.

PMID: 30982587
DOI: 10.1016/j.jtcvs.2019.02.016

Abstract

Objective: Cardiopulmonary exercise testing (CPET) for patients awaiting lung resection for non-small cell lung cancer (NSCLC) has developed considerably in recent years. Pulmonary rehabilitation before surgery (prehabilitation) improves postoperative risk factors such as forced expiratory volume in 1 second and peak oxygen consumption (VO_2peak). Ventilatory inefficiency assessed according to the linear regression of the ratio between the increase in minute ventilation and the expired carbon dioxide flow during CPET (VE/VCO₂ slope) >35, is a high-risk factor for postoperative complications. Our objective was to assess the effect of prehabilitation on VE/VCO2 slope, and its relationship with VO_2peak.

Methods: This retrospective cohort study was performed between January 1, 2014 and December 31, 2017 at Rouen University Hospital. One hundred fifty-two patients with NSCLC awaiting lung surgery who underwent CPET were screened. A total of 50 patients who underwent CPET before and after prehabilitation were included.

Results: VE/VCO₂ slope did not change significantly after prehabilitation (median, 37.1 [25th-75th percentile, 33.8-43.4] vs median, 35.4 [25th-75th percentile, 31.1-40.5]; P = .09), whereas VO_2peak increased significantly (from a median of 13.2 [25th-75th percentile, 11.9-14.7] to a median of 14.8 [25th-75th percentile, 13.1-16.4] mL/kg/min). The number of patients with a high risk of postoperative complications (ie, VE/VCO₂ slope >35) did not change significantly after prehabilitation. Cardiorespiratory parameters improved significantly more in patients who underwent at least 15 sessions of ambulatory prehabilitation.

Conclusions: VE/VCO₂ slope, a known predictor of favorable surgical outcomes in patients with NSCLC, did not change with the prehabilitation program used in this study, despite clear improvements in VO_2peak and other CPET measures. Larger, prospective studies are needed to confirm the results of this study.

Keywords: lung resection; non–small cell lung cancer; prehabilitation; pulmonary rehabilitation; ventilatory efficiency.

MeSH terms

Breathing Exercises* / methods
Carcinoma, Non-Small-Cell Lung / physiopathology
Carcinoma, Non-Small-Cell Lung / surgery*
Carcinoma, Non-Small-Cell Lung / therapy
Exercise Test
Female
Humans
Lung Neoplasms / physiopathology
Lung Neoplasms / surgery*
Lung Neoplasms / therapy
Male
Middle Aged
Postoperative Complications / prevention & control
Respiratory Function Tests
Retrospective Studies