Preoperative pulmonary rehabilitation in patients with lung cancer and chronic obstructive pulmonary disease

OBJECTIVES: Impaired cardiopulmonary reserve is the main cause of inoperability in non-small-cell lung cancer (NSCLC). This study aims to evaluate the role of a preoperative pulmonary rehabilitation (PPR) programme in the improvement of functional parameters, which can enable an increase in the number of patients eligible for surgery. METHODS: From January 2008 to June 2011, we observed a uniform group of 27 patients with NSCLC and chronic obstructive pulmonary disease (COPD). It showed: (i) a body mass index of 21.5 +/- 2 kg/m(2); (ii) forced expiratory volume in 1 s (FEV1) of 1.14 +/- 0.7 l; (iii) maximal peak of oxygen consumption (VO(2)max) of 12.9 +/- 1.8 ml/kg/min; (iv) carbon monoxide diffusing capacity (DLCO) of 72 +/- 3% predicted; (v) stage IB of lung cancer. All patients underwent a 4-week PPR programme, 6 days a week and were re-evaluated before inclusion for surgery. RESULTS: The rehabilitation programme was completed by all patients and extended by 2 weeks in nine patients, in order to obtain a further functional improvement. A statistically significant increase has been in the values of PaO2 (60 +/- 10 vs 82 +/- 12 mmHg), of VO(2)max (12.9 +/- 1.8 vs 19.2 +/- 2.1 ml/kg/min, P = 0.00001) and of FEV1 (1.14 +/- 0.7 vs 1.65 +/- 0.8 l, P = 0.02). All patients underwent a lobectomy, with a postoperative morbidity of 15%. CONCLUSIONS: A 4 to 6-week PPR programme prepares the NSCLC and COPD patients properly for the surgical approach, reducing the functional limitations of inoperability.