Preoperative pulmonary rehabilitation training to reduce the serum surfactant protein D (SP-D) level and postoperative pulmonary complications of lung cancer surgery with high risk factors: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAO Ke ^1,2 , LAI Yutian ¹ , HANG Jian ¹ , WANG Yifan ¹ , WANG Xiaowei ² ,  CHE Guowei ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Thoracic and Cardiovascular Surgery, The Second People's Hospital of Chengdu, Chengdu, 610017, P.R.China;

Corresponding author：

CHE Guowei, Email: guowei_che@yahoo.com

Keywords：

Preoperative pulmonary rehabilitation training; surfactant protein D (SP-D); pulmonary complications; lung cancer

DOI：

10.7507/1007-4848.201701003

Video：

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Objective To research the relationship between decrease of serum surfactant protein D (SP-D) level reduced by pulmonary rehabilitation training and postoperative pulmonary complications (PPC). Methods From May 2015 through December 2015, 80 consecutive non-small cell lung cancer (NSCLC) patients with surgical treatment in West China Hospital, who were at least with a high risk factor, were randomly divided into two groups including a group R and a group C. There were 36 patients with 25 males and 11 females at age of 63.98±8.32 years in the group R and 44 patients with 32 males and 12 females at age of 64.58±6.71 years in the group C.The group R underwent an intensive preoperative pulmonary rehabilitation (PR) training for one week, and then with lobectomy. The group C underwent only lobectomy with conventional perioperative managements. Postoperative pulmonary complications, average days in hospital, other clinic data and the serum SP-D level in a series of time from the date of admission to discharge (5 time points) were analyzed. Results The incidence of PPC in the group R was 5.56%(2/36),which was lower than that in the group C (P=0.032). The descender of the serum SP-D level of the patients in the group R (30.75±5.57 ng/mlvs. 24.22±3.08 ng/ml) was more obvious than that in the group C (31.16±7.81 ng/mlvs. 30.29±5.80 ng/ml,P=0.012). The descender of the serum SP-D level of the patients with PPC was more obvious than that of patients without PPC (P=0.012). Conclusion The preoperative PR training could reduce the PPC of lung cancer surgery with high risk factors. The serum SP-D level could reflect the effect of preoperative pulmonary rehabilitation training.

Citation： GAO Ke, LAI Yutian, HANG Jian, WANG Yifan, WANG Xiaowei, CHE Guowei. Preoperative pulmonary rehabilitation training to reduce the serum surfactant protein D (SP-D) level and postoperative pulmonary complications of lung cancer surgery with high risk factors: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(5): 330-337. doi: 10.7507/1007-4848.201701003 Copy

1.	Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Translational lung cancer research. Transl Lung Cancer Res, 2015, 4(4): 327-338.
2.	Torchio R, Guglielmo M, Giardino R, et al. Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2010, 38(1): 14-19.
3.	潘友民, 潘铁成, 张良华, 等. 呼吸训练改善肺癌患者手术后肺功能和生存质量的临床研究. 中华物理医学与康复杂志, 2005, 27(9): 548-550.
4.	Gao K, Yu PM, Su JH, et al. Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: A study for 342 cases. Thorac Cancer, 2015, 6(4): 443-449.
5.	Mei J, Liu L, Tang M, et al. Airway bacterial colonization in patients with non-small cell lung cancer and the alterations during the perioperative period. J Thorac Dis, 2014, 6(9): 1200-1208.
6.	苏建华, 喻鹏铭, 周渝斌, 等. 影响肺癌手术住院费用和快速康复的临床因素分析. 中国肺癌杂志, 2014, 17(7): 536-540.
7.	沈春辉, 梅龙勇, 喻鹏铭, 等. 术前肺康复对肺癌合并中-重度慢性阻塞性肺疾病患者运动耐力影响. 中国胸心血管外科临床杂志, 2011, 18(6): 514-517.
8.	Kaneda H, Nakano T, Taniguchi Y, et al. Impact of previous gastrectomy on postoperative pneumonia after pulmonary resection in lung cancer patients. Interact Cardiovasc Thorac Surg, 2012, 14(6): 750-753.
9.	Savardekar A, Gyurmey T, Agarwal R, et al. Incidence, risk factors, and outcome of postoperative pneumonia after microsurgical clipping of ruptured intracranial aneurysms. Surg Neurol Int, 2013, 4: 24.
10.	蒲强, 马林, 车国卫, 等. 单向式胸腔镜肺叶切除安全性及技术可行性研究——附 1 040 例报告.四川大学学报: 医学版, 2013, 44(1): 106-113.
11.	Lugg ST, Agostini PJ, Tikka T, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 2016, 71(2): 171-176.
12.	Nici L. Preoperative and postoperative pulmonary rehabilitation in lung cancer patients. Thorac Surg Clin, 2008, 18(1): 39-43.
13.	Rodriguez-Larrad A, Lascurain-Aguirrebena I, Abecia-Inchaurregui LC, et al. Perioperative physiotherapy in patients undergoing lung cancer resection. Interact Cardiovasc Thorac Surg, 2014, 19(2): 269-281.
14.	Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med, 2009, 76(Suppl 4): S60-S65.
15.	Morano MT, Araujo AS, Nascimento FB, et al. Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(1): 53-58.
16.	Coats V, Maltais F, Simard S, et al. Feasibility and effectiveness of a home-based exercise training program before lung resection surgery. Can Respir J, 2013, 20(2): e10-e16.
17.	Mujovic N, Mujovic N, Subotic D, et al. Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease. Arch Med Sci, 2014, 10(1): 68-75.
18.	Nagarajan K, Bennett A, Agostini P, et al. Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? Interact Cardiovasc Thorac Surg, 2011, 13(3): 300-302.
19.	Paone G, Conti V, Biondi-Zoccai G, et al. Long-term home noninvasive mechanical ventilation increases systemic inflammatory response in chronic obstructive pulmonary disease: a prospective observational study. Mediators Inflamm, 2014, 2014: 503145. doi: 10.1155/2014/503145.
20.	Morano MT, Mesquita R, Da Silva GP, et al. Comparison of the effects of pulmonary rehabilitation with chest physical therapy on the levels of fibrinogen and albumin in patients with lung cancer awaiting lung resection: a randomized clinical trial. BMC Pulm Med, 2014, 14: 121.
21.	Bade G, Khan MA, Srivastava AK, et al. Serum cytokine profiling and enrichment analysis reveal the involvement of immunological and inflammatory pathways in stable patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2014, 9: 759-773.
22.	De Cicco M. The prothrombotic state in cancer: pathogenic mechanisms. Crit Rev Oncol Hematol, 2004, 50(3): 187-196.
23.	Jehn M, Schindler C, Meyer A, et al. Associations of daily walking activity with biomarkers related to cardiac distress in patients with chronic obstructive pulmonary disease. Respiration, 2013, 85(3): 195-202.
24.	Rosenberg SR, Kalhan R. Biomarkers in chronic obstructive pulmonary disease. Transl Res, 2012, 159(3): 228-237.
25.	Lomas DA, Silverman EK, Edwards LD, et al. Serum surfactant protein D is steroid sensitive and associated with exacerbations of COPD. Eur Respir J, 2009, 34(1): 95-102.
26.	Ofek I, Mesika A, Kalina M, et al. Surfactant protein D enhances phagocytosis and killing of unencapsulated phase variants of Klebsiella pneumoniae. Infection and immunity, 2001, 69 (1): 24-33.
27.	罗曼, 陈平, 刘绍坤, 等. 肺表面活性物质相关蛋白质-D 在慢性阻塞性肺疾病大鼠肺组织中的表达. 中华结核和呼吸杂志, 2010, 33(12): 935-936.
28.	Pitsavos C, Chrysohoou C, Panagiotakos DB, et al. Association of leisure-time physical activity on inflammation markers (C-reactive protein, white cell blood count, serum amyloid A, and fibrinogen) in healthy subjects (from the ATTICA study). Am J Cardiol, 2003, 91(3): 368-370.
29.	Jones LW, Eves ND, Peddle CJ, et al. Effects of presurgical exercise training on systemic inflammatory markers among patients with malignant lung lesions. Appl Physiol Nutr Metab, 2009, 34(2): 197-202.

1. Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Translational lung cancer research. Transl Lung Cancer Res, 2015, 4(4): 327-338.
2. Torchio R, Guglielmo M, Giardino R, et al. Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2010, 38(1): 14-19.
3. 潘友民, 潘铁成, 张良华, 等. 呼吸训练改善肺癌患者手术后肺功能和生存质量的临床研究. 中华物理医学与康复杂志, 2005, 27(9): 548-550.
4. Gao K, Yu PM, Su JH, et al. Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: A study for 342 cases. Thorac Cancer, 2015, 6(4): 443-449.
5. Mei J, Liu L, Tang M, et al. Airway bacterial colonization in patients with non-small cell lung cancer and the alterations during the perioperative period. J Thorac Dis, 2014, 6(9): 1200-1208.
6. 苏建华, 喻鹏铭, 周渝斌, 等. 影响肺癌手术住院费用和快速康复的临床因素分析. 中国肺癌杂志, 2014, 17(7): 536-540.
7. 沈春辉, 梅龙勇, 喻鹏铭, 等. 术前肺康复对肺癌合并中-重度慢性阻塞性肺疾病患者运动耐力影响. 中国胸心血管外科临床杂志, 2011, 18(6): 514-517.
8. Kaneda H, Nakano T, Taniguchi Y, et al. Impact of previous gastrectomy on postoperative pneumonia after pulmonary resection in lung cancer patients. Interact Cardiovasc Thorac Surg, 2012, 14(6): 750-753.
9. Savardekar A, Gyurmey T, Agarwal R, et al. Incidence, risk factors, and outcome of postoperative pneumonia after microsurgical clipping of ruptured intracranial aneurysms. Surg Neurol Int, 2013, 4: 24.
10. 蒲强, 马林, 车国卫, 等. 单向式胸腔镜肺叶切除安全性及技术可行性研究——附 1 040 例报告.四川大学学报: 医学版, 2013, 44(1): 106-113.
11. Lugg ST, Agostini PJ, Tikka T, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 2016, 71(2): 171-176.
12. Nici L. Preoperative and postoperative pulmonary rehabilitation in lung cancer patients. Thorac Surg Clin, 2008, 18(1): 39-43.
13. Rodriguez-Larrad A, Lascurain-Aguirrebena I, Abecia-Inchaurregui LC, et al. Perioperative physiotherapy in patients undergoing lung cancer resection. Interact Cardiovasc Thorac Surg, 2014, 19(2): 269-281.
14. Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med, 2009, 76(Suppl 4): S60-S65.
15. Morano MT, Araujo AS, Nascimento FB, et al. Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(1): 53-58.
16. Coats V, Maltais F, Simard S, et al. Feasibility and effectiveness of a home-based exercise training program before lung resection surgery. Can Respir J, 2013, 20(2): e10-e16.
17. Mujovic N, Mujovic N, Subotic D, et al. Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease. Arch Med Sci, 2014, 10(1): 68-75.
18. Nagarajan K, Bennett A, Agostini P, et al. Is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? Interact Cardiovasc Thorac Surg, 2011, 13(3): 300-302.
19. Paone G, Conti V, Biondi-Zoccai G, et al. Long-term home noninvasive mechanical ventilation increases systemic inflammatory response in chronic obstructive pulmonary disease: a prospective observational study. Mediators Inflamm, 2014, 2014: 503145. doi: 10.1155/2014/503145.
20. Morano MT, Mesquita R, Da Silva GP, et al. Comparison of the effects of pulmonary rehabilitation with chest physical therapy on the levels of fibrinogen and albumin in patients with lung cancer awaiting lung resection: a randomized clinical trial. BMC Pulm Med, 2014, 14: 121.
21. Bade G, Khan MA, Srivastava AK, et al. Serum cytokine profiling and enrichment analysis reveal the involvement of immunological and inflammatory pathways in stable patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2014, 9: 759-773.
22. De Cicco M. The prothrombotic state in cancer: pathogenic mechanisms. Crit Rev Oncol Hematol, 2004, 50(3): 187-196.
23. Jehn M, Schindler C, Meyer A, et al. Associations of daily walking activity with biomarkers related to cardiac distress in patients with chronic obstructive pulmonary disease. Respiration, 2013, 85(3): 195-202.
24. Rosenberg SR, Kalhan R. Biomarkers in chronic obstructive pulmonary disease. Transl Res, 2012, 159(3): 228-237.
25. Lomas DA, Silverman EK, Edwards LD, et al. Serum surfactant protein D is steroid sensitive and associated with exacerbations of COPD. Eur Respir J, 2009, 34(1): 95-102.
26. Ofek I, Mesika A, Kalina M, et al. Surfactant protein D enhances phagocytosis and killing of unencapsulated phase variants of Klebsiella pneumoniae. Infection and immunity, 2001, 69 (1): 24-33.
27. 罗曼, 陈平, 刘绍坤, 等. 肺表面活性物质相关蛋白质-D 在慢性阻塞性肺疾病大鼠肺组织中的表达. 中华结核和呼吸杂志, 2010, 33(12): 935-936.
28. Pitsavos C, Chrysohoou C, Panagiotakos DB, et al. Association of leisure-time physical activity on inflammation markers (C-reactive protein, white cell blood count, serum amyloid A, and fibrinogen) in healthy subjects (from the ATTICA study). Am J Cardiol, 2003, 91(3): 368-370.
29. Jones LW, Eves ND, Peddle CJ, et al. Effects of presurgical exercise training on systemic inflammatory markers among patients with malignant lung lesions. Appl Physiol Nutr Metab, 2009, 34(2): 197-202.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Preoperative pulmonary rehabilitation training to reduce the serum surfactant protein D (SP-D) level and postoperative pulmonary complications of lung cancer surgery with high risk factors: A randomized controlled trial

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