Effect of prehabilitation on ventilatory efficiency in non-small cell lung cancer patients: A cohort study.

Gravier FE, Bonnevie T, Boujibar F, Médrinal C, Prieur G, Combret Y, Muir JF, Cuvelier A, Baste JM, Debeaumont D

J Thorac Cardiovasc Surg. 2019 Feb 19. pii: S0022-5223(19)30448-9

OBJECTIVE: Cardiopulmonary exercise testing (CPET) for patients awaiting lung
resection for non-small cell lung cancer (NSCLC) has developed considerably in
recent years. Pulmonary rehabilitation before surgery (prehabilitation) improves
postoperative risk factors such as forced expiratory volume in 1 second and peak
oxygen consumption (VO2peak). Ventilatory inefficiency assessed according to the
linear regression of the ratio between the increase in minute ventilation and the
expired carbon dioxide flow during CPET (VE/VCO2 slope) >35, is a high-risk
factor for postoperative complications. Our objective was to assess the effect of
prehabilitation on VE/VCO2 slope, and its relationship with VO2peak.
METHODS: This retrospective cohort study was performed between January 1, 2014
and December 31, 2017 at Rouen University Hospital. One hundred fifty-two
patients with NSCLC awaiting lung surgery who underwent CPET were screened. A
total of 50 patients who underwent CPET before and after prehabilitation were
RESULTS: VE/VCO2 slope did not change significantly after prehabilitation
(median, 37.1 [25th-75th percentile, 33.8-43.4] vs median, 35.4 [25th-75th
percentile, 31.1-40.5]; P = .09), whereas VO2peak increased significantly (from a
median of 13.2 [25th-75th percentile, 11.9-14.7] to a median of 14.8 [25th-75th
percentile, 13.1-16.4] mL/kg/min). The number of patients with a high risk of
postoperative complications (ie, VE/VCO2 slope >35) did not change significantly
after prehabilitation. Cardiorespiratory parameters improved significantly more
in patients who underwent at least 15 sessions of ambulatory prehabilitation.
CONCLUSIONS: VE/VCO2 slope, a known predictor of favorable surgical outcomes in
patients with NSCLC, did not change with the prehabilitation program used in this
study, despite clear improvements in VO2peak and other CPET measures. Larger,
prospective studies are needed to confirm the results of this study.