ABSTRACT
Lung parenchyma resection is the treatment of choice for early-stage lung cancer. The surgery involves the loss of respiratory surface and consequently leads to reduction in exercise capacity. Proper rehabilitation is essential for restoring the function and good performance of the respiratory system. Rehabilitation should be an integral part of surgical treatment. It should be implemented early and maintained until full restoration of function and fitness. The paper discusses the physiotherapeutic procedure in patients after lung parenchyma resection. Under current guidelines, the recommended physiotherapeutic approach has been described as a multi-stage process. A preoperative exercise program can prepare the patient better for surgery and reduce the risk of some postoperative complications. Since there is a tendency to shorten the hospital stay, guidelines in preparation for surgery have been developed in the form of leaflets given to patients. In specifically described perioperative treatment we can see the physiotherapeutic procedures that the patient, after lung parenchyma resection, may undergo. Physiotherapy protocol was documented using a proposed patient's card that described the basic treatment and included additional space for comments, in case of complications etc. Post-hospital rehabilitation, described in accordance with current guidelines, complements the treatment after surgery as a whole. To achieve the goals of rehabilitation a team of closely cooperating specialists must emerge. It should include physicians, physiotherapists, nurses, psychologists and occupational therapists. Family support plays a significant role as well. Proper education for patients and informing them about the purposefulness of the treatment are very significant factors. Further analysis allowed the creation of an algorithm for physiotherapeutic care in patients without complications after lung cancer surgery.
Subject(s)
Lung Neoplasms/rehabilitation , Physical Therapy Modalities , Postoperative Care/methods , Humans , Lung Neoplasms/surgery , Patient Care Team/organization & administration , Preoperative Care/methodsABSTRACT
OBJECTIVES: Low-dose computed tomography (LDCT) screening improves lung cancer prognosis but also results in diagnostic work-up and surgical treatment in many individuals without cancer. Therefore, we analysed the procedures that screening participants underwent to better understand the extent of overdiagnosis. METHODS: Between 2009 and 2011, 8649 healthy volunteers aged 50-75 years with a 20 pack-year smoking history underwent LDCT screening, of whom individuals with detected lung nodules had 2 years control. Participants with a nodule >10 mm in diameter or with suspected tumour morphology underwent diagnostic work-up: 283 (6%)/4694 (54%) screened participants had detected lung nodules. One hundred and four individuals underwent surgery, 27 underwent oncological treatment and 152 without a cancer diagnosis underwent further follow-up with LDCT. RESULTS: In 75% of participants accepted for diagnostic work-up and 25% of surgical patients, the procedures were unnecessary. In 70 (24.7%) participants, a specific diagnosis was obtained mainly due to the low efficacy of fine needle aspiration biopsy [sensitivity, 65.2%; negative predictive value (NPV), 95.9%] and bronchofiberoscopy (sensitivity, 71.4%; NPV, 50%) caused by overinterpretation of LDCT [positive predictive value (PPV), 2%]. Of 104 (36.7%) surgical patients, 43 (41.4%) had a preoperative cancer diagnosis, and 61 (58.6%) underwent surgery without pathological examination. In the latter group, intervention was justified in 35 (57.3%) patients. Complications occurred in 49 (17.3%) participants subjected to diagnostic work-up. In surgical patients, 67 (64.4%) malignant and 37 (35.6%) benign lesions were resected. In the latter group, intervention was justified in only 11 (29.7%) patients. No patient died because of diagnostic or treatment procedures during the study. The complication rate was 14.5% in the malignant and 10.8% in the benign groups. A neoplasm was found in 94 screening participants, of whom 67 (71.3%) underwent surgery; the remaining 27 (28.7%) patients were not surgical candidates. Adenocarcinoma accounted for 49/67 (73%) patients who underwent surgery for non-small-cell lung cancer (NSCLC); 56/67 (84%) patients had stage I NSCLC, and 26/67 (38%) underwent video-assisted thoracoscopic surgery lobectomy. CONCLUSIONS: Futile diagnostic work-ups and operations must be reduced before LDCT screening can be broadly used. Stage I adenocarcinoma dominated in the NSCLC patients who underwent surgery.
