THE CONCEPT OF PREHABILITATION IN THORACIC SURGERY: A SYSTEMATIC LITERATURE REVIEW
DOI:
https://doi.org/10.31379/2411.2616.18.2.4Keywords:
prehabilitation, preoperative exercises, respiratory parameters, VATS, spirometry, lung cancer.Abstract
Introduction. Lung cancer is the most common type of cancer in the world, responsible for 13.0% of cases of all cancers. Surgery is the optimal treatment for operable lung cancer and increases the survival rate of these patients. However, as with any oncological surgery, complications are a substantial cause of morbidity and mortality. The prehabilitation program has been proposed as preoperative adjuvant therapy to circumvent the given consequences, but existing studies show controversial results. Purpose and task. In this article, we review the evolution of the evidence base for prehabilitation before lung resection, the potential components of such a program, and how these programs can be integrated into the surgical treatment plan for lung cancer and aim to identify the role of this program in elevating respiratory parameters and reducing patients’ postoperative complications. Material and methods. A search of the electronic databases was requested: PubMed, clinicaltrials.gov, rcpjournals.org for randomized clinical trials that investigated the effectiveness of the prehabilitation concept and its influence on functional parameters, postoperative complications, and patient’s quality of life. The primary endpoint was the ability of prehabilitation to increase the values of respiratory parameters of patients undergoing lung resections. The secondary parameters investigated were: postoperative complications, functional capacity assessed preand postoperatively, length of hospitalization, and cost of hospitalization. Results. Ten clinical trials (698 patients) were included in the review. The quality of the studies was assessed using Delphi criteria. The impact of the targeted program in improving the respiratory parameters of patients was analyzed in 10 out of 10 studies, the incidence of respiratory complications in 9 out of 10 studies and the duration of hospitalization in 5 out of 10 studies. The results obtained can be classified as controversial, depending on the type of study, the size of the lots and the duration, intensity and multidisciplinarity of the prehabilitation program. Conclusion. It is obvious that prehabilitation needs to be comprehensively integrated into medical practice because this is a lucid hope for cancer patients. However, there remains a clear need to assess the effectiveness of the prehabilitation program in specific populations.
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