Preoperative physiotherapy for improving the reserve capacity in a patient with esophageal cancer and frailty: A case report.

IF 1.5 Q3 REHABILITATION Physiotherapy Research International Pub Date : 2024-10-01 DOI:10.1002/pri.2138
Yusuke Takahashi, Kazuki Okura, Ririko Sakamoto, Kakeru Hasegawa, Yushi Nagaki, Akiyuki Wakita, Yusuke Sato
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Abstract

Introduction: Frailty is significantly correlated with a higher incidence of medical complications during hospitalization after esophagectomy. As frailty is thought to be a reversible condition, improving the reserve capacity through preoperative physical therapy is expected to reduce the risk of postoperative pulmonary complications (PPCs). Herein, we report our experience with preoperative physical therapy in a patient with esophageal cancer who was considered to have inadequate fitness for surgery owing to poor physical performance.

Case presentation: A 72-year-old man (height: 169.5 cm, weight: 54.7 kg, body mass index: 18.9 kg/m2) with esophagogastric junction tumors (cStage IIIA) was hospitalized and scheduled to undergo surgery based on preoperative screening. He was categorized as frail according to the revised Japanese version of the Cardiovascular Health Study criteria and the Mini Nutritional Assessment Short-Form indicated severe malnutrition. We focused on physical therapy to improve exercise tolerance and prevent PPCs and devised a short-term intensive physical therapy program comprising minimal exercises that the patient could perform efficiently. The program consisted of only inspiratory muscle training and aerobic exercises. His maximal inspiratory pressure (MIP) and 6-min walking distance improved by 30 cm H2O and 145 m, respectively, on the day before surgery compared with those on day 8. The percentage predicted value of the MIP improved from 56.6% at the start of physical therapy to 102.9% on the day before surgery. On day 43, the patient underwent subtotal esophagectomy and was able to ambulate on postoperative day 5 without respiratory complications.

Conclusion: We conducted a short-term, intensive, and minimal preoperative physical therapy program for a patient with esophageal cancer who had physical frailty. Preoperative physical therapy to increase the reserve capacity may result in a favorable postoperative course even in patients with physical frailty.

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通过术前物理治疗提高食道癌合并体弱患者的储备能力:病例报告。
简介虚弱与食管切除术后住院期间较高的医疗并发症发生率明显相关。由于虚弱被认为是一种可逆的状况,因此通过术前物理治疗来提高储备能力有望降低术后肺部并发症(PPCs)的风险。在此,我们报告了我们对一名食道癌患者进行术前物理治疗的经验,该患者因体能状况不佳而被认为不适合手术:一位 72 岁的男性(身高:169.5 厘米,体重:54.7 千克,体重指数:18.9 千克/平方米)患有食管胃交界处肿瘤(c 阶段 IIIA),根据术前筛查结果住院并计划接受手术。根据日本修订版心血管健康研究标准,他被归类为体弱者,而迷你营养评估短表显示他严重营养不良。我们将重点放在物理治疗上,以提高患者的运动耐受力,预防 PPCs,并制定了一个短期强化物理治疗计划,其中包括患者能够有效完成的最低限度的运动。该计划仅包括吸气肌训练和有氧运动。与第 8 天相比,患者手术前一天的最大吸气压力(MIP)和 6 分钟步行距离分别提高了 30 厘米水深和 145 米。MIP 预测值的百分比从物理治疗开始时的 56.6% 提高到了手术前一天的 102.9%。第 43 天,患者接受了食管次全切除术,术后第 5 天就可以下床活动,没有出现呼吸系统并发症:我们为一名身体虚弱的食管癌患者实施了短期、强化和最低限度的术前物理治疗计划。即使是体质虚弱的食管癌患者,通过术前物理治疗来提高储备能力也能使其术后恢复良好。
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来源期刊
CiteScore
3.30
自引率
5.90%
发文量
53
期刊介绍: Physiotherapy Research International is an international peer reviewed journal dedicated to the exchange of knowledge that is directly relevant to specialist areas of physiotherapy theory, practice, and research. Our aim is to promote a high level of scholarship and build on the current evidence base to inform the advancement of the physiotherapy profession. We publish original research on a wide range of topics e.g. Primary research testing new physiotherapy treatments; methodological research; measurement and outcome research and qualitative research of interest to researchers, clinicians and educators. Further, we aim to publish high quality papers that represent the range of cultures and settings where physiotherapy services are delivered. We attract a wide readership from physiotherapists and others working in diverse clinical and academic settings. We aim to promote an international debate amongst the profession about current best evidence based practice. Papers are directed primarily towards the physiotherapy profession, but can be relevant to a wide range of professional groups. The growth of interdisciplinary research is also key to our aims and scope, and we encourage relevant submissions from other professional groups. The journal actively encourages submissions which utilise a breadth of different methodologies and research designs to facilitate addressing key questions related to the physiotherapy practice. PRI seeks to encourage good quality topical debates on a range of relevant issues and promote critical reflection on decision making and implementation of physiotherapy interventions.
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