title: Preoperative pulmonary rehabilitation in patients with lung cancer and chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  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/m2;; (ii) forced expiratory volume in 1 s (FEV(1)) 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 PaO(2) (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 FEV(1) (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.
authors.affiliation: Department of Thoracic Surgery, University of L'Aquila, G. Mazzini Hospital, Teramo, Italy. duilio.divisi@aslteramo.it
authors.forename: Duilio
authors.initials: D
authors.lastname: Divisi
authors.forename: Cinzia
authors.initials: C
authors.lastname: Di Francesco
authors.forename: Gabriella
authors.initials: G
authors.lastname: Di Leonardo
authors.forename: Roberto
authors.initials: R
authors.lastname: Crisci
mesh_terms: D000230:Adenocarcinoma / Q000534:rehabilitation / Q000601:surgery; D001784:Blood Gas Analysis; D001945:Breathing Exercises; D002289:Carcinoma, Non-Small-Cell Lung / Q000534:rehabilitation* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000534:rehabilitation / Q000601:surgery; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation* / Q000601:surgery; D014797:Vital Capacity / Q000502:physiology