title: [Pulmonary rehabilitation and non-invasive ventilation before lung surgery in very high-risk patients].
abstract: BACKGROUND
  The benefits of a rehabilitation program before surgical lung cancer resection remain to be defined. The purpose of this prospective observational study was to assess the effects of rehabilitation together with the use of noninvasive ventilation (NIV) in patients who were at a high operative risk.
  
  
  METHODS
  Between January 2010 and June 2011, 20 consecutive patients (16 males, four females, mean age: 66 years [44-79]) with a clinical N0 non-small cell lung cancer were included. Eligibility criteria were predicted post-operative respiratory function (FEV1, VO2 max) below the guideline thresholds for eligibility for surgical resection and/or associated with severe co-morbidities. The protocol included a cardiorespiratory rehabilitation program and 3 hours of NIV each day. Functional tests were repeated after 3 weeks of therapy.
  
  
  RESULTS
  Participants displayed a significant increase in their FEV1 and VO2 max, which allowed surgical resection to go ahead in all patients (lobectomy, n=15; pneumonectomy, n=3; bilobectomy, n=2). The morbidity rate was 20% (acute renal failure, n=2; pneumonia, n=1; haemothorax, n=1). The mortality rate was 5% (myocardial infarction, n=1). Further postoperative rehabilitation allowed a return at home in 19 patients after a mean hospital stay of 11 days.
  
  
  CONCLUSIONS
  Pulmonary rehabilitation associated with a period of preoperative NIV allows surgery to be performed in patients who are not initially eligible for resection. An evaluation of long-term outcomes survival in comparison to non-surgical therapies is necessary.
authors.affiliation: Service de chirurgie thoracique et vasculaire, centre hospitalier Victor-Dupouy, rue du lieutenant Prudhon, 95100 Argenteuil, France. patrick.bagan@ch-argenteuil.fr
authors.forename: P
authors.initials: P
authors.lastname: Bagan
authors.forename: V
authors.initials: V
authors.lastname: Oltean
authors.forename: A
authors.initials: A
authors.lastname: Ben Abdesselam
authors.forename: B
authors.initials: B
authors.lastname: Dakhil
authors.forename: C
authors.initials: C
authors.lastname: Raynaud
authors.forename: J-C
authors.initials: JC
authors.lastname: Couffinhal
authors.forename: H
authors.initials: H
authors.lastname: De Crémoux
mesh_terms: D000328:Adult; D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods* / Q000706:statistics & numerical data; D011013:Pneumonectomy / Q000534:rehabilitation* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D057234:Preoperative Period; D012306:Risk