The Optimal Time of High-Intensity Pre-rehabilitation for Surgical Lung Cancer Patients: A Retrospective Cohort Study with 4452 Patients

• Published in: Annals of surgical oncology 2025, Vol.32 (1), p.265-273
• Main Authors: Lai, Yutian, Dong, Yingxian, Tian, Long, Li, Hongjun, Ye, Xinyi, Che, Guowei
• Format: Article
• Language: English
• Subjects: Aged; Complications; Female; Follow-Up Studies; Humans; Lung cancer; Lung Neoplasms - rehabilitation; Lung Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Nonlinear systems; Oncology; Pneumonectomy; Postoperative; Postoperative Complications; Preoperative Exercise; Prognosis; Rehabilitation; Retrospective Studies; Surgery; Surgical Oncology; Thoracic Oncology; Time Factors
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-16054-6

Background The aim of this study was to investigate the influence of the time of pre-rehabilitation (PR) combined with respiratory training and aerobic exercise on surgical patients with lung cancer. Patients and Methods A retrospective study from a 5-year database of a single center, including patients with lung cancer who underwent surgery between 1 January 2016 and 31 December 2020, was conducted. The patients were divided into the PR group, in which they received the PR regimen, and the non-PR group, in which they received routine care. Results A total of 4452 patients were retrospectively included, 684 of whom received PR regimen. A lower postoperative pulmonary complication (PPC) rate was observed in PR group than in non-PR group before or after propensity score matching (PSM) (before: 12.6% vs 18.5%, P < 0.001; after: 12.6% vs 18.7%, P < 0.001). For the PR group, a restricted cubic spline model revealed a significant nonlinear dose‒response association between PR time and the occurrence of PPCs ( P for nonlinearity = 0.002). The PR time associated with the lowest occurrence of PPCs was 7 days, and the odds ratio (OR) of PPCs decreased steeply, with an OR of 0.8 [95% confidence interval (CI) 0.66–0.97] per day until 7 days, and then remained stable with a slight increase afterward with an OR of 1.11 (95% CI 0.99–1.25) per day. Conclusion The study validated the effectiveness of a pre-rehabilitation regimen for decreasing the occurrence of PPCs. A U-shaped nonlinear relationship was found between pre-rehabilitation time and the PPC rate, indicating that both excessive and insufficient pre-rehabilitation time may increase the incidence of PPCs. Registry Number : ChiCTR1800020097.