Effect of inspiratory muscle training in esophageal cancer patients receiving esophagectomy: A meta-analysis of randomized controlled trials.

ABSTRACT

PURPOSE: To identify the clinical effect of inspiratory muscle training (IMT) among esophageal cancer patients undergoing esophagectomy based on randomized controlled trials (RCTs). METHODS: Several databases were searched for relevant RCTs up to August 23, 2023. Primary outcomes were respiratory muscle function, including the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and pulmonary function, including the forced expiratory volume in one second % (FEV1%), forced vital capacity% (FVC%), maximal ventilator volume (MVV), FEV1/FVC% and FVC. The secondary outcomes were exercise performance, including the six-minute walk distance test (6MWT) and Borg index; mental function and quality of life, as evaluated by the Hospital Anxiety Depression Scale (HADS) and Nottingham Health Profile (NHP) score; and postoperative complications. All the statistical analyses were performed with REVMAN 5.3 software. RESULTS: Eight RCTs were included in this meta-analysis, with 368 patients receiving IMT and 371 control subjects. The pooled results demonstrated that IMT could significantly enhance respiratory muscle function (MIP MD = 7.14 cmH2O, P = 0.006; MEP MD = 8.15 cmH2O, P<0.001) and pulmonary function (FEV1% MD = 6.15%, P<0.001; FVC% MD = 4.65%, P<0.001; MVV MD = 8.66 L, P<0.001; FEV1/FVC% MD = 5.27%, P = 0.03; FVC MD = 0.50 L, P<0.001). Furthermore, IMT improved exercise performance (6MWT MD = 66.99 m, P = 0.02; Borg index MD = -1.09, P<0.001), mental function and quality of life (HADS anxiety score MD = -2.26, P<0.001; HADS depression score MD = -1.34, P<0.001; NHP total score MD = -48.76, P<0.001). However, IMT did not significantly decrease the incidence of postoperative complications. CONCLUSION: IMT improves clinical outcomes, such as respiratory muscle function and pulmonary function, in esophageal cancer patients receiving esophagectomy and has potential for broad applications in the clinic.