Positive effects of a perioperative training intervention in Ivor Lewis oesophageal surgery: a randomised, controlled multicentre trial

Abstract

Background: The effects of peri-operative training interventions in connection with oesophageal surgery have not been thoroughly investigated. The aim of this randomised, controlled, single-blind study was to evaluate a peri-operative physical training programme in patients undergoing oesophageal cancer resection surgery due to cancer of the oesophagus or the gastro-oesophageal junction. Methods: One hundred patients scheduled to undergo Ivor Lewis oesophagectomy in one of five university hospitals in Sweden were randomised to a control group or intervention including respiratory muscle training, strength training, and increased physical activity before surgery and up to 3 months postoperatively. Outcome measures were physical capacity, respiratory muscle strength, spirometry, grip strength, and chest mobility. Questionnaires regarding physical activity and function, recovery, and health-related quality of life were completed at inclusion and 3 and 12 months postoperatively. Results: We did not find significant differences between the groups in physical capacity during follow-up. However, the intervention group performed significantly better than the control group in maximal inspiratory pressure (Δ18%), maximal expiratory pressure (Δ18%), and peak expiratory flow (Δ12%) 3 months postoperatively (p < 0.05). Patients in the intervention group also developed fewer pulmonary complications (p = 0.019). We did not find differences between the groups in recovery or health-related quality of life. Conclusion: A peri-operative training intervention including respiratory muscle training had a positive impact on respiratory function and pulmonary complications. However, neither strength training nor increased physical activity had any effects. Thus, respiratory muscle training may be offered as a peri-operative regimen in oesophageal cancer surgery. Trial registration: FoU i VGR 238,651 (Released Dec 15, 2017), Clinical Trials NCT03452319 (Released Feb 18, 2018).