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Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer
  1. Daniel Steffens1,2,
  2. Paula R Beckenkamp3,
  3. Mark Hancock4,
  4. Michael Solomon1,2,5,
  5. Jane Young1,2,5
  1. 1 Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
  2. 2 School of Public Health, The University of Sydney, Sydney, NSW, Australia
  3. 3 Musculoskeletal Health, Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
  4. 4 Faculty of Medicine and Health Sciences, Discipline of Physiotherapy, Macquarie University, Sydney, NSW, Australia
  5. 5 Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
  1. Correspondence to Dr Daniel Steffens, Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH) and Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia; daniel.steffens{at}health.nsw.gov.au

Abstract

Objective To investigate the effectiveness of preoperative exercises interventions in patients undergoing oncological surgery, on postoperative complications, length of hospital stay and quality of life.

Design Intervention systematic review with meta-analysis.

Data sources MEDLINE, Embase and PEDro.

Eligibility criteria for selecting studies Trials investigating the effectiveness of preoperative exercise for any oncological patient undergoing surgery were included. The outcomes of interest were postoperative complications, length of hospital stay and quality of life. Relative risks (RRs), mean differences (MDs) and 95% CI were calculated using random-effects models.

Results Seventeen articles (reporting on 13 different trials) involving 806 individual participants and 6 tumour types were included. There was moderate-quality evidence that preoperative exercise significantly reduced postoperative complication rates (RR 0.52, 95% CI 0.36 to 0.74) and length of hospital stay (MD −2.86 days, 95% CI −5.40 to −0.33) in patients undergoing lung resection, compared with control. For patients with oesophageal cancer, preoperative exercise was not effective in reducing length of hospital stay (MD 2.00 days, 95% CI −2.35 to 6.35). Although only assessed in individual studies, preoperative exercise improved postoperative quality of life in patients with oral or prostate cancer. No effect was found in patients with colon and colorectal liver metastases.

Conclusions Preoperative exercise was effective in reducing postoperative complications and length of hospital stay in patients with lung cancer. Whether preoperative exercise reduces complications, length of hospital stay and improves quality of life in other groups of patients undergoing oncological surgery is uncertain as the quality of evidence is low.

  • exercise
  • surgery
  • cancer
  • review
  • meta-analysis

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Footnotes

  • Contributors DS, PRB, MH, MS and JY conceived and designed the study, analysed and interpreted the data, and contributed by drafting the article. MH, MS and JY provided statistical expertise. DS and PRB collected and assembled the data. DS is guarantor. All authors participated in the revision and final approval of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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