Comprehensive Preoperative Pulmonary Rehabilitation Including Intensive Nutritional Support Reduces the Postoperative Morbidity Rate of Sarcopenia-Related Patients with Lung Cancer

Abstract

Since surgical resection is the treatment of choice for localized lung cancer, it is important to develop an effective strategy to reduce the risk of postoperative complications caused by poor preoperative conditions. We prospectively implemented a comprehensive preoperative pulmonary rehabilitation (CHPPR) program that includes intensive nutritional support with branched-chain amino acids and herbal medicine supplementation concomitant with potential high-intensity physical therapy through an interdisciplinary team approach. This study aimed to evaluate whether CHPPR is beneficial for elderly, low body weight (percentage ideal body weight <90%) patients scheduled to undergo lung surgery. Between 2006 and 2015, 171 patients aged >70 years underwent standard lobectomy for lung cancers. Of these, 12 patients with a low body weight (sarcopenia-related, Group A) and 62 patients without a low body weight (sarcopenia-unrelated, Group B) underwent surgery after CHPPR. Twenty-four patients with a low body weight (sarcopenia-related, Group C) and 73 patients without a low body weight (sarcopenia-unrelated, Group D) refused CHPPR. The postoperative morbidity rates of patients in Groups A, B, C, and D were 17%, 16%, 63%, and 21%, respectively. Of the patients in the sarcopenia-related groups (Groups A and C), those who participated in the CHPPR program (Group A) had a significantly lower morbidity rate than those who did not participate in the CHPPR program (Group C) (P = 0.014). The CHPPR program is beneficial in reducing the postoperative morbidity rate of sarcopenia-related patients scheduled to undergo pulmonary resection.