Efficacy and safety of perioperative comprehensive management in patients with non-small cell lung cancer combined with chronic obstructive pulmonary disease: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAO Hua ¹ , ZHAO Ye ² , FENG Haiming ³ , YANG Jianbao ³ , JING Tao ³ , ZHAO Sihua ³ , LIN Junping ³ ,  LI Bin ³

1. Department of Outpatient, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, P.R.China;
2. Respiratory Department, Lanzhou University First Hospital, Lanzhou University First Clinical Medical College, Lanzhou, 730030, P.R.China;
3. Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, P.R.China;

Corresponding?author：

LI Bin, Email: dr.leebin@outlook.com

Keywords：

Non-small cell lung cancer; chronic obstructive pulmonary disease; perioperative period; visualization; meta-analysis

DOI：

10.7507/1007-4848.201711097

Video：

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Objective To evaluate the efficacy and safety of perioperative comprehensive management in non- small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD). Methods Clinical studies about effect of different perioperative comprehensive management on patients with early NSCLC combined with COPD were searched from PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang databases from inception to November 1st, 2017. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and Stata 14.0 softwares. Results A total of 20 articles were identified including 1 079 patients. The results of meta-analysis showed that perioperative comprehensive management improved the forced vital capacity (FVC), maximum minute ventilation (MVV), predictive value of postoperative one-second rate (ppoFEV1%), carbon monoxide diffusing capacity (DLCO) and percent forced expiratory volume in one second (FEV1%) (MD=–0.47, 95%CI –0.62 to –0.32, P<0.000 01; MD=–0.17, 95%CI –0.22 to –0.11, P<0.000 01; MD=–4.24, 95%CI –5.37 to –3.11, P<0.000 01; MD=–7.54, 95%CI –8.33 to –6.76, P<0.000 01; MD=–1.33, 95%CI –2.16 to –0.50, P=0.002; MD=–6.93, 95%CI –9.45 to –4.41, P<0.000 1, respectively). However, there was no significant difference in the rate of DLCO (DLCO%) and ventilation at maximal workload (VEmax) between pre- and post-management (MD=–2.91, 95%CI –11.31 to 5.50, P=0.5; MD= 0.18, 95%CI –2.23 to 2.58, P=0.89, respectively). With regard to cardiac function, perioperative comprehensive management improved the maximal oxygen consumption (VO₂max), 6-minute walk distance (6MWD) and anaerobic threshold (AT) (MD=–2.28, 95%CI –3.41 to –1.15, P<0.000 1; MD=–57.77, 95%CI –77.90 to –37.64, P<0.000 1; MD=–2.71, 95%CI –3.30 to –2.12, P<0.000 1, respectively). As to complications, compared with conventional treatment group, perioperative comprehensive management group had fewer postoperative short-term complications (OR=0.39, 95%CI 0.26 to 0.58, P<0.000 01). Besides, perioperative comprehensive management also shortened hospital stay (MD=–2.38, 95%CI –3.86 to –0.89, P=0.002). Conclusion Perioperative comprehensive management can significantly improve lung function in patients with NSCLC combined with COPD, reduce short-term postoperative pulmonary complications and shorten the hospital stay with good efficacy and safety.

Citation： GAO Hua, ZHAO Ye, FENG Haiming, YANG Jianbao, JING Tao, ZHAO Sihua, LIN Junping, LI Bin. Efficacy and safety of perioperative comprehensive management in patients with non-small cell lung cancer combined with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 306-315. doi: 10.7507/1007-4848.201711097 Copy

1.	Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg, 2006, 81(5): 1830-1837.
2.	Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e166S-e190S.
3.	Ribas J, Jiménez MJ, Barberà JA, et al. Gas exchange and pulmonary hemodynamics during lung resection in patients at increased risk: relationship with preoperative exercise testing. Chest, 2001, 120(3): 852-859.
4.	Gottlieb M, Marsaa K, Godtfredsen NS, et al. Prevalence and management of pulmonary comorbidity in patients with lung and head and neck cancer. Acta Oncol, 2015, 54(5): 767-771.
5.	支修益, 何建行, 劉倫旭, 等. 多學科圍手術期氣道管理專家共識(2016 年版). 中國胸心血管外科臨床雜志, 2016, 21(7): 641-645.
6.	Benzo R, Wigle D, Novotny P, et al. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Lung Cancer, 2011, 74(3): 441-445.
7.	B?lükbas S, Eberlein M, Eckhoff J, et al. Short-term effects of inhalative tiotropium/formoterol/budenoside versus tiotropium/formoterol in patients with newly diagnosed chronic obstructive pulmonary disease requiring surgery for lung cancer: a prospective randomized trial. Eur J Cardiothorac Surg, 2011, 39(6): 995-1000.
8.	Lai Y, Su J, Yang M, et al. Impact and effect of preoperative short-term pulmonary rehabilitation training on lung cancer patients with mild to moderate chronic obstructive pulmonary disease: A randomized trial. Zhongguo Fei Ai Za Zhi, 2016, 19(11): 746-753.
9.	Refai M, Brunelli A, Xiumé F, et al. Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial. Eur J Cardiothorac Surg, 2009, 35(3): 469-473.
10.	Stefanelli F, Meoli I, Cobuccio R, et al. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Eur J Cardiothorac Surg, 2013, 44(4): e260-e265.
11.	倪高順, 陳洋. 綜合物理治療對肺癌合并慢性阻塞性肺疾病患者術后肺功能的影響. 中國呼吸與危重監護雜志, 2017, 16(4): 318-323.
12.	方翼, 趙擎宇, 黃東鋒, 等. 運動訓練對低肺功能肺癌患者手術耐受性的影響. 中國康復醫學雜志, 2013, 28(7): 619-623.
13.	賀斌, 李新, 張鵬, 等. 術前運動訓練對肺癌合并 COPD 患者圍術期心肺功能的影響. 山東醫藥, 2015, 55(18): 21-23.
14.	Borges RC, Carvalho CR. Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Arch Phys Med Rehabil, 2014, 95(9): 1638-1645.
15.	Bobbio A, Chetta A, Ampollini L, et al. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg, 2008, 33(1): 95-98.
16.	沈春輝, 梅龍勇, 喻鵬銘, 等. 術前肺康復對肺癌合并中-重度慢性阻塞性肺疾病患者運動耐力的影響. 中國胸心血管外科臨床雜志, 2011, 18(6): 514-517.
17.	申瑞娟, 楊魯民, 李靖, 等. 中重度 COPD 并肺癌患者圍手術期肺功能保護的臨床研究. 中國現代醫學雜志, 2011, 21(28): 3551-3554.
18.	郭志強. 中重度 COPD 并肺癌老年患者圍術期肺功能的變化及保護. 中國老年學雜志, 2013, 33(22): 5559-5560.
19.	Kobayashi S, Suzuki S, Niikawa H, et al. Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD. Respirology, 2009, 14(5): 675-679.
20.	Divisi D, Di Francesco C, Di Leonardo G, et al. Preoperative pulmonary rehabilitation in patients with lung cancer and chronic obstructive pulmonary disease. Eur J Cardiothorac Surg, 2013, 43(2): 293-296.
21.	Matsuura Y. Effectiveness of NRST about preoperative management of respiratory surgery in our hospital. Chest, 2011, 140(4): 527A.
22.	Mujovic N, Mujovic N, Subotic D, et al. Influence of pulmonary rehabilitation on lung function changes after the lung resection for primary lung cancer in patients with chronic obstructive pulmonary disease. Aging Dis, 2015, 6(6): 466-477.
23.	Sekine Y, Chiyo M, Iwata T, et al. Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Jpn J Thorac Cardiovasc Surg, 2005, 53(5): 237-243.
24.	Nojiri T, Inoue M, Yamamoto K, et al. Inhaled tiotropium to prevent postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery. Surg Today, 2014, 44(2): 285-290.
25.	Saito H, Hatakeyama K, Konno H, et al. Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease. Thorac Cancer, 2017, 8(5): 451-460.
26.	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
27.	Caramori G, Casolari P, Cavallesco GN, et al. Mechanisms involved in lung cancer development in COPD. Int J Biochem Cell Biol, 2011, 43(7): 1030-1044.
28.	McLeod RS, Aarts MA, Chung F, et al. Development of an enhanced recovery after surgery guideline and implementation strategy based on the knowledge-to-action cycle. Ann Surg, 2015, 262(6): 1016-1025.
29.	Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest, 2007, 131(5 Suppl): 4S-42S.
30.	中國加速康復外科專家組. 中國加速康復外科圍手術期管理專家共識(2016). 中華外科雜志, 2016, 54(6): 413-418.
31.	Lee SH, Kim N, Lee CY, et al. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: A randomised double-blinded trial. Eur J Anaesthesiol, 2016, 33(4): 275-282.
32.	Vagvolgyi A, Rozgonyi Z, Kerti M, et al. Effectiveness of perioperative pulmonary rehabilitation in thoracic surgery. J Thorac Dis, 2017, 9(6): 1584-1591.
33.	Laurent H, Galvaing G, Thivat E, et al. Effect of an intensive 3-week preoperative home rehabilitation programme in patients with chronic obstructive pulmonary disease eligible for lung cancer surgery: a multicentre randomised controlled trial. BMJ Open, 2017, 7(11): e017307.

1. Licker MJ, Widikker I, Robert J, et al. Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. Ann Thorac Surg, 2006, 81(5): 1830-1837.
2. Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e166S-e190S.
3. Ribas J, Jiménez MJ, Barberà JA, et al. Gas exchange and pulmonary hemodynamics during lung resection in patients at increased risk: relationship with preoperative exercise testing. Chest, 2001, 120(3): 852-859.
4. Gottlieb M, Marsaa K, Godtfredsen NS, et al. Prevalence and management of pulmonary comorbidity in patients with lung and head and neck cancer. Acta Oncol, 2015, 54(5): 767-771.
5. 支修益, 何建行, 劉倫旭, 等. 多學科圍手術期氣道管理專家共識(2016 年版). 中國胸心血管外科臨床雜志, 2016, 21(7): 641-645.
6. Benzo R, Wigle D, Novotny P, et al. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Lung Cancer, 2011, 74(3): 441-445.
7. B?lükbas S, Eberlein M, Eckhoff J, et al. Short-term effects of inhalative tiotropium/formoterol/budenoside versus tiotropium/formoterol in patients with newly diagnosed chronic obstructive pulmonary disease requiring surgery for lung cancer: a prospective randomized trial. Eur J Cardiothorac Surg, 2011, 39(6): 995-1000.
8. Lai Y, Su J, Yang M, et al. Impact and effect of preoperative short-term pulmonary rehabilitation training on lung cancer patients with mild to moderate chronic obstructive pulmonary disease: A randomized trial. Zhongguo Fei Ai Za Zhi, 2016, 19(11): 746-753.
9. Refai M, Brunelli A, Xiumé F, et al. Short-term perioperative treatment with ambroxol reduces pulmonary complications and hospital costs after pulmonary lobectomy: a randomized trial. Eur J Cardiothorac Surg, 2009, 35(3): 469-473.
10. Stefanelli F, Meoli I, Cobuccio R, et al. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Eur J Cardiothorac Surg, 2013, 44(4): e260-e265.
11. 倪高順, 陳洋. 綜合物理治療對肺癌合并慢性阻塞性肺疾病患者術后肺功能的影響. 中國呼吸與危重監護雜志, 2017, 16(4): 318-323.
12. 方翼, 趙擎宇, 黃東鋒, 等. 運動訓練對低肺功能肺癌患者手術耐受性的影響. 中國康復醫學雜志, 2013, 28(7): 619-623.
13. 賀斌, 李新, 張鵬, 等. 術前運動訓練對肺癌合并 COPD 患者圍術期心肺功能的影響. 山東醫藥, 2015, 55(18): 21-23.
14. Borges RC, Carvalho CR. Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Arch Phys Med Rehabil, 2014, 95(9): 1638-1645.
15. Bobbio A, Chetta A, Ampollini L, et al. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg, 2008, 33(1): 95-98.
16. 沈春輝, 梅龍勇, 喻鵬銘, 等. 術前肺康復對肺癌合并中-重度慢性阻塞性肺疾病患者運動耐力的影響. 中國胸心血管外科臨床雜志, 2011, 18(6): 514-517.
17. 申瑞娟, 楊魯民, 李靖, 等. 中重度 COPD 并肺癌患者圍手術期肺功能保護的臨床研究. 中國現代醫學雜志, 2011, 21(28): 3551-3554.
18. 郭志強. 中重度 COPD 并肺癌老年患者圍術期肺功能的變化及保護. 中國老年學雜志, 2013, 33(22): 5559-5560.
19. Kobayashi S, Suzuki S, Niikawa H, et al. Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD. Respirology, 2009, 14(5): 675-679.
20. Divisi D, Di Francesco C, Di Leonardo G, et al. Preoperative pulmonary rehabilitation in patients with lung cancer and chronic obstructive pulmonary disease. Eur J Cardiothorac Surg, 2013, 43(2): 293-296.
21. Matsuura Y. Effectiveness of NRST about preoperative management of respiratory surgery in our hospital. Chest, 2011, 140(4): 527A.
22. Mujovic N, Mujovic N, Subotic D, et al. Influence of pulmonary rehabilitation on lung function changes after the lung resection for primary lung cancer in patients with chronic obstructive pulmonary disease. Aging Dis, 2015, 6(6): 466-477.
23. Sekine Y, Chiyo M, Iwata T, et al. Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Jpn J Thorac Cardiovasc Surg, 2005, 53(5): 237-243.
24. Nojiri T, Inoue M, Yamamoto K, et al. Inhaled tiotropium to prevent postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery. Surg Today, 2014, 44(2): 285-290.
25. Saito H, Hatakeyama K, Konno H, et al. Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease. Thorac Cancer, 2017, 8(5): 451-460.
26. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin, 2015, 65(2): 87-108.
27. Caramori G, Casolari P, Cavallesco GN, et al. Mechanisms involved in lung cancer development in COPD. Int J Biochem Cell Biol, 2011, 43(7): 1030-1044.
28. McLeod RS, Aarts MA, Chung F, et al. Development of an enhanced recovery after surgery guideline and implementation strategy based on the knowledge-to-action cycle. Ann Surg, 2015, 262(6): 1016-1025.
29. Ries AL, Bauldoff GS, Carlin BW, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest, 2007, 131(5 Suppl): 4S-42S.
30. 中國加速康復外科專家組. 中國加速康復外科圍手術期管理專家共識(2016). 中華外科雜志, 2016, 54(6): 413-418.
31. Lee SH, Kim N, Lee CY, et al. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: A randomised double-blinded trial. Eur J Anaesthesiol, 2016, 33(4): 275-282.
32. Vagvolgyi A, Rozgonyi Z, Kerti M, et al. Effectiveness of perioperative pulmonary rehabilitation in thoracic surgery. J Thorac Dis, 2017, 9(6): 1584-1591.
33. Laurent H, Galvaing G, Thivat E, et al. Effect of an intensive 3-week preoperative home rehabilitation programme in patients with chronic obstructive pulmonary disease eligible for lung cancer surgery: a multicentre randomised controlled trial. BMJ Open, 2017, 7(11): e017307.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and safety of perioperative comprehensive management in patients with non-small cell lung cancer combined with chronic obstructive pulmonary disease: A systematic review and meta-analysis

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