Preoperative exercise training decreases complications of minimally invasive lung cancer surgery: A randomized controlled trial

IF 4.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thoracic and Cardiovascular Surgery Pub Date : 2025-02-01 DOI:10.1016/j.jtcvs.2024.04.009

Nanjiang Zhou MD , Jeffrey W. Ripley-Gonzalez MSc , Wenliang Zhang MD, PhD , Kangling Xie MD, PhD , Baiyang You MD, PhD , Yanan Shen MMed , Zeng Cao MPT , Ling Qiu MD , Cui Li MD , Siqian Fu MD , Chunfang Zhang MD, PhD , Yaoshan Dun MMed, PhD , Yang Gao MD, PhD , Suixin Liu MD, PhD

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Abstract

Objective

Limited evidence exists regarding the efficacy of preoperative exercise in reducing short-term complications after minimally invasive surgery in patients with non–small cell lung cancer. This study aims to investigate the impact of preoperative exercise on short-term complications after minimally invasive lung resection.

Methods

In this prospective, open-label, randomized (1:1) controlled trial at Xiangya Hospital, China (September 2020 to February 2022), patients were randomly assigned to a preoperative exercise group with 16-day alternate supervised exercise or a control group. The primary outcome assessed was short-term postoperative complications, with a follow-up period of 30 days postsurgery.

Results

A total of 124 patients were recruited (preoperative exercise group n = 62; control n = 62). Finally, 101 patients (preoperative exercise group; n = 51 and control; n = 50) with a median age of 56 years (interquartile range, 50-62 years) completed the study. Compared with the control group, the preoperative exercise group showed fewer postoperative complications (preoperative exercise 3/51 vs control 10/50; odds ratio, 0.17; 95% CI, 0.04-0.86; P = .03) and shorter hospital stays (mean difference, −2; 95% CI, −3 to −1; P = .01). Preoperative exercise significantly improved depression, stress, functional capacity, and quality of life (all P < .05) before surgery. Furthermore, preoperative exercise demonstrated a significantly lower minimum blood pressure during surgery and lower increases in body temperature on day 2 after surgery, neutrophil-to-lymphocyte ratio, and neutrophil count after surgery (all P < .05). Exploratory research on lung tissue RNA sequencing (5 in each group) showed downregulation of the tumor necrosis factor signaling pathway in the preoperative exercise group compared with the control group.

Conclusions

Preoperative exercise training decreased short-term postoperative complications in patients with non–small cell lung cancer.

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术前运动训练可减少微创肺癌手术并发症--一项随机对照试验。

目的：术前运动对减少非小细胞肺癌微创手术后短期并发症的影响，目前证据有限。本研究旨在探讨术前运动对微创肺切除术后短期并发症的影响。方法该前瞻性、开放标签、随机（1:1）对照试验于2020年9月至2022年2月在中国湘雅医院进行，患者被随机分配到术前运动组和对照组，对照组有16天的监督交替运动。评估的主要结局是术后短期并发症，术后随访30天。结果共纳入124例患者(术前运动组n = 62；对照组n = 62)。最后，101例患者(术前运动组；N = 51，对照组；N = 50)，中位年龄56岁（四分位数范围50-62岁）完成研究。与对照组相比，术前运动组术后并发症较少(术前运动3/51 vs对照组10/50；优势比0.17；95% ci, 0.04-0.86；P = .03)和更短的住院时间(平均差异为- 2；95% CI,−3 ~−1；p = 0.01)。术前运动可显著改善抑郁、压力、功能能力和生活质量(P <；.05)。此外，术前运动显示手术期间最低血压明显降低，术后第2天体温升高明显降低，中性粒细胞与淋巴细胞比值和术后中性粒细胞计数(P <；. 05)。探索性研究肺组织RNA测序（每组5个）显示，术前运动组肿瘤坏死因子信号通路较对照组下调。结论运动训练可降低非小细胞肺癌患者术后短期并发症的发生率。

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来源期刊

Journal of Thoracic and Cardiovascular Surgery 医学-呼吸系统

CiteScore

11.20

自引率

10.00%

发文量

1079

审稿时长

68 days

期刊介绍： The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.