ABSTRACT
Lung parenchyma resection is the treatment of choice for early-stage lung cancer. The surgery involves the loss of respiratory surface and consequently leads to reduction in exercise capacity. Proper rehabilitation is essential for restoring the function and good performance of the respiratory system. Rehabilitation should be an integral part of surgical treatment. It should be implemented early and maintained until full restoration of function and fitness. The paper discusses the physiotherapeutic procedure in patients after lung parenchyma resection. Under current guidelines, the recommended physiotherapeutic approach has been described as a multi-stage process. A preoperative exercise program can prepare the patient better for surgery and reduce the risk of some postoperative complications. Since there is a tendency to shorten the hospital stay, guidelines in preparation for surgery have been developed in the form of leaflets given to patients. In specifically described perioperative treatment we can see the physiotherapeutic procedures that the patient, after lung parenchyma resection, may undergo. Physiotherapy protocol was documented using a proposed patient's card that described the basic treatment and included additional space for comments, in case of complications etc. Post-hospital rehabilitation, described in accordance with current guidelines, complements the treatment after surgery as a whole. To achieve the goals of rehabilitation a team of closely cooperating specialists must emerge. It should include physicians, physiotherapists, nurses, psychologists and occupational therapists. Family support plays a significant role as well. Proper education for patients and informing them about the purposefulness of the treatment are very significant factors. Further analysis allowed the creation of an algorithm for physiotherapeutic care in patients without complications after lung cancer surgery.
Subject(s)
Lung Neoplasms/rehabilitation , Physical Therapy Modalities , Postoperative Care/methods , Humans , Lung Neoplasms/surgery , Patient Care Team/organization & administration , Preoperative Care/methodsABSTRACT
BACKGROUND: The prediction of postoperative functional status in non-small cell lung cancer patients based on preoperative assessment of physical and respiratory capacity is inadequate based on recent RCTs. MATERIAL AND METHODS: Prospectively collected spirometry data and the six-minute walk test results of 57 patients treated with lobectomy for non-small cell lung cancer were analyzed. The tests were performed before surgery, and 30 and 90 days after lobectomy. All patients underwent a respiratory functional and physical capacity assessment. RESULTS: All 57 patients underwent lobectomy. Before surgery, mean FEV1 was 2.4 ± 0.7 L, corresponding to %FEV1 of 88.3 ± 17.3%. The mean absolute and expected 6MWT distance was 548 ± 74.6 m and 108.9 ± 14.5%, respectively. At the first postoperative evaluation 30 days after surgery, FEV1 and %FEV1 decreased significantly by an average of 0.5 ± 0.3 L and 15.1 ± 10.7%, while 6MWT and expected 6MWT decreased minimally by an average of 1.0 m and 0.8%, respectively. Three months after lobectomy, FEV1 and %FEV1, compared with the initial assessment, decreased by an average of 0.3 ± 0.3 l and 7.8 ± 10.0%, while 6MWT and its expected score increased to 564.6 ± 84.6 m and 112.8 ± 15.8%, respectively. CONCLUSIONS: After lobectomy, FEV1 decreased slightly and less than expected, while 6MWT increased proportionally compared to the preoperative evaluation.