The Impact Of Trimodal Prehabilitation Strategy On Perioperative Functional Capability And Prognosis For Patients Undergoing Thoracoscopic Lobectomy

Background:The process of enhancing an individual's functional capacity to optimize physiologic reserves before an operation to withstand the stress of surgery has been coined prehabilitation.The aim of this study was to explore the prehabilitation strategy and its practical application in patients who will receive elective thoracoscopic lobectomy in China,and thus to evaluate the impact of the home-based trimodal prehabilitation strategy on perioperative functional capacity and prognosis for patients undergoing thoracoscopic lobectomy for lung cancer.Methods:This is a prospective single blind randomized controlled trial conducted from December 2016 to May 2017.A total of one hundred patients were randomized into prehabilitation group(n = 50)or control group(n = 50).The prehabilitation group received a home-based preoperative trimodal intervention including aerobic exercises,resistance exercises,respiratory exercises,nutritional counseling with whey protein supplementation and psychological therapy,as well as conventional guidance.The intervention time was determined by the waiting time till surgery alone,which is around 2?3 weeks.The control group will receive the conventional guidance,including preoperative anesthesia assessment,drug treatment recommendations for chronic disease and smoking cessation.The follow-up of patients started from the time when the physician and the patient decided to undergo the thoracoscopic lobectomy until 30 days after surgery.The primary outcome was perioperative(the day before operation and 30 days postoperative)functional capability measured using the validated six-minute walk test.Secondary outcome included perioperative pulmonary function,the changes of hospital anxiety and depression scale(HADS)score,World Health Organization disability assessment schedule II(WHODAS 2.0)score,postoperative quality of recovery score-9(QoR-9)score,hospital stay,hospitalization cost,ICU stay,thoracic drainage and postoperative complications.Data were collected and analyzed with IBM SPSS Statistics 22.0.Results:(1)100 patients were enrolled in the study and 40 patients(20 in the prehabilitation group and 20 in the control group)received operations and finished follow-up for 30 days.There was no significant difference in age,sex composition,body mass index,6-minute walk distance(6MWD),pulmonary function,and other preoperative examination.(2)Average duration of prehabilitation intervention was 15.3 days before surgery.And the average waiting time in control group was 17.2 days.The follow-up time was 31.2 and 31.3 days after surgery in prehabilitation and control group respectively.(3)There was no significant difference in blood gas analysis when entering operating room,intraoperative vital signs,liquid intake and output,operation time,and surgical approach.(4)Changes in 6MWD in the prehabilitation group were significantly higher compared to control group during the preoperative period(58m ± 49m vs.3m ±28m,P<0.001)and at 30 days postoperatively(25m±63m vs.-36m±57m,P<0.001).(5)The improvement of forced expiratory volume in one second(FEV1)in the prehabilitation group at the day before operation was statistically significant comparing with control group(0.2L ± 0.3L vs.0.0L ± 0.2L,P=0.027).But there was no significant difference in preoperative forced vital capacity(FVC)and peak expiratory flow(PEF).And no difference was seen in postoperative lung function between two groups.(6)There was no difference in perioperative HADS and WHODAS 2.0 score.There was no difference in QoR-9 score in the first 3 days postoperatively.(7)Prehabilitation group had a significant reduction in thoracic drainage on the first day postoperatively(176 ml vs.239 ml,P=0.027).However,there was no significant difference in hospitalization time,hospitalization cost and postoperative complications.Conclusions:Trimodal prehabilitation strategy significantly improved the perioperative functional capability of patients undergoing thoracoscopic lobectomy.Meaningful changes of preoperative lung function can be achieved with a prehabilitation program,which may give more patients the surgical opportunities.The trimodal prehabilitation reduced postoperative thoracic drainage,and may enhanced postoperative recovery.