Postoperative outcomes of preoperative exercise training in patients with operable non-small cell lung cancer: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 41018094 · doi:10.3389/fonc.2025.1563478
What was done
A systematic review and meta-analysis of four databases (Medline, Embase, Web of Science, and CENTRAL) was conducted to evaluate randomized controlled trials (RCTs) comparing preoperative exercise training versus no preoperative exercise in lung cancer patients scheduled for lung resection. The primary outcomes were postoperative complications and postoperative length of hospital stay. Secondary outcomes included pulmonary function, severe postoperative complications, 30-day mortality, chest tube drainage duration, dyspnea, and health-related quality of life (HRQoL).
What was found
Across 16 RCTs with 1,022 individuals, preoperative exercise training significantly reduced postoperative complications (OR = 0.33, 95% CI: 0.24 to 0.46, P < 0.0001), severe postoperative complications (OR = 0.35, 95% CI: 0.21 to 0.56, P < 0.0001), and postoperative length of hospital stay (95% CI: -3.11 to -1.40, P < 0.0001; point estimate not reported). It also significantly improved FEV1% predicted (95% CI: 5.30 to 8.10, P < 0.0001), FVC% predicted (95% CI: 1.90 to 4.23, P < 0.0001), peak expiratory flow (95% CI: 12.44 to 60.93, P = 0.003), peak oxygen uptake (VO2peak) (95% CI: 2.41 to 4.17, P < 0.0001), and reduced post-intervention dyspnea (95% CI: -0.61 to 0.04, P = 0.02). No statistically significant differences were found for absolute FEV1, absolute FVC, DLCO, 6-minute walk distance, 30-day mortality, chest tube drainage duration, or HRQoL.
Why it matters
Prehabilitation with exercise prior to lung cancer resection substantially reduces the risk of postoperative complications and shortens hospital stays, providing clear evidence for its inclusion in pre-surgical care.
Limits
The abstract does not specify the exercise protocols (frequency, intensity, modality, or duration), adherence rates, or point estimates (mean differences) for several continuous outcomes. Individual included trials were small (averaging ~64 patients per trial). No significant improvements were observed for 30-day mortality, walk distance, or quality of life.
Cited by
- contradicts Preoperative exercise in cancer patients improves physical fitness and post-surgical function, but research has not demonstrated significant reductions in hospital length of stay or surgical complications.