Preoperative Pulmonary Rehabilitation
Abstract
The incidence of lung cancer continues to increase and now represents the most common fatal malignancy in adults. At the present time, surgery is the most optimal form of therapy for patients with non-small-cell lung cancer. Unfortunately, many of these patients have significant underlying respiratory diseases including emphysema and airway hyper-reactivity that clearly increase the incidence of perioperative morbidity and mortality. Although many approaches have been de signed to select those candidates best suited for sur gery, there exists a significant number of patients who, in spite of advanced comorbid pulmonary disease, could benefit from surgical resection. The question that now exists is how best to manage their pulmonary disease in the preoperative period to minimize postop erative morbidity and mortality. Cessation of smoking, bronchodilator, and steroid therapy are helpful, but limited in their ability to improve overall pulmonary function. Pulmonary rehabilitation programs have tradi tionally been designed for nonsurgical candidates with chronic lung disease. Randomized, controlled trials of graded exercise have shown potential benefit with improved quality of life and functional status. Similar preoperative programs have not been systematically explored in the surgical population. Described is an attempt to evaluate, in a randomized fashion, a home- based exercise program specifically applied to high-risk thoracic surgical patients.