Ann Thorac Surg 2007;84:202
© 2007 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
Douglas E. Paull, MD
Department of Surgery, Wright State University Boonshoft School of Medicine, VA Medical Center, 4100 W. Third St, Dayton, OH 45428
(Email: douglas.paull{at}wright.edu).
Thoracic surgeons utilize a spectrum of observations in predicting a patient’s risk for pulmonary resection. Clinical factors (eg, dyspnea and smoking), pulmonary function tests, and arterial blood gas analysis are complemented by exercise testing that can range from simple stair climbing to more sophisticated studies such as the laboratory measurement of maximal oxygen consumption [1]. Treadmill exercise tests are simple, widely available, demonstrate evidence of myocardial ischemia predictive of cardiac events, and quantitate exercise capacity.
The major finding in this study was that preoperative exercise capacity (measured as metabolic equivalents [METs] calculated from the treadmill performance during exercise stress echocardiography) was highly predictive of postoperative length of stay (LOS) among patients undergoing pulmonary resection for malignancy [2]. Furthermore, the inverse relationship between preoperative exercise capacity and LOS was independent of the confounding variables operation type, dyspnea, gender, and smoking history. A threshold of 7 METs separated patients into high and low risk for prolonged LOS.
As suggested by the authors, a subgroup of thoracic surgical patients with poor exercise tolerance has thus been identified who may benefit from a short course of preoperative rehabilitation. Pulmonary rehabilitation has been shown to increase exercise capacity, improve quality of life, and improve outcomes in patients with chronic obstructive pulmonary disease undergoing lung-volume reduction surgery, as well as pulmonary resection for malignancy [3–5].
Thoracic surgeons are positioned perfectly to conduct larger, prospective, randomized controlled trials to determine definitively whether brief rehabilitation programs lead to improvement in preoperative exercise capacity and better postoperative outcomes in marginally fit patients with resectable lung cancer.
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References
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- Deslauriers J, Mehran R. Handbook of perioperative care in general thoracic surgery. Philadelphia: Mosby Inc; 2005.
- Weinstein H, Bates AT, Spaltro BE, Thaler HT, Steingart RM. Influence of preoperative exercise capacity on length of stay after thoracic cancer surgery Ann Thorac Surg 2007;84:197-202.[Abstract/Free Full Text]
- Spruit MA, Janssen PP, Willemsen SCP, Hochstenbag MMH, Wouters EFM. Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study Lung Cancer 2006;52:257-260.[Medline]
- Ries AL, Make BJ, Lee SM, et al. The effects of pulmonary rehabilitation in the national emphysema treatment trial Chest 2005;128:3799-3809.[Medline]
- Takaoka ST, Weinacker AB. The value of preoperative pulmonary rehabilitation Thorac Surg Clin 2005;15:203-211.[Medline]
Related Article
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Influence of Preoperative Exercise Capacity on Length of Stay After Thoracic Cancer Surgery
- Howard Weinstein, Andrew T. Bates, Barbara E. Spaltro, Howard T. Thaler, and Richard M. Steingart
Ann. Thorac. Surg. 2007 84: 197-202.
[Abstract]
[Full Text]
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