Skip to main content
Log in

Effect of early mobilization on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery on the esophagus

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

Esophagectomy performed via thoracotomy is associated with a high rate of postoperative pulmonary complications. Video-assisted thoracoscopic surgery at the esophagus (VATS-E) can reduce the rate of postoperative pulmonary complications. VATS-E is being increasingly implemented owing to its benefits. This procedure makes early patient mobilization possible, because there is minimal thoracic wall invasion, and thus, less postoperative pain. This study aimed to identify the efficacy of early mobilization in patients undergoing VATS-E.

Methods

We retrospectively reviewed the patients who underwent VATS-E between November 2008 and October 2016. All the patients underwent preoperative physiotherapy and postoperative early mobilization for standard perioperative management. We examined the relation between early mobilization and the factors affecting postoperative pulmonary complications and the duration of physiotherapy with regard to the surgical outcome of VATS-E.

Results

A total of 118 patients who underwent VATS-E were assessed. The incidence of postoperative pulmonary atelectasis decreased with early mobilization, and earlier mobilization was associated with a better decrease (P < 0.001). Multiple logistic regression analysis identified the percentage of volume capacity [odds ratio (OR) 0.96; 95% confidence interval (CI) 0.93–0.99] and initial walking (OR 1.82; 95% CI 1.40–2.48) as independent risk factors for postoperative pulmonary atelectasis. In addition, the presence or absence of atelectasis was found to reduce the necessary period of physiotherapy (P < 0.001).

Conclusion

Our results indicated that early mobilization reduces the incidence of postoperative pulmonary atelectasis, which may also contribute to early recovery in patients who undergo VATS-E.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002;123(4):661–9.

    Article  PubMed  Google Scholar 

  2. Feeney C, Hussey J, Carey M, et al. Assessment of physical fitness for esophageal surgery, and targeting interventions to optimize outcomes. Dis Esophagus. 2010;23(7):529–39.

    Article  CAS  PubMed  Google Scholar 

  3. Taguchi S, Osugi H, Higashino M, et al. Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc. 2003;17(9):1445–50.

    Article  CAS  PubMed  Google Scholar 

  4. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379(9829):1887–92.

    Article  PubMed  Google Scholar 

  5. Smithers BM, Gotley DC, Martin I, et al. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245(2):232–40.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pasquina P, Tramèr MR, Granier JM, et al. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest. 2006;130(6):1887–99.

    Article  PubMed  Google Scholar 

  7. Cao S, Zhao G, Cui J, et al. Fast-track rehabilitation program and conventional care after esophagectomy: a retrospective controlled cohort study. Support Care Cancer. 2013;21(3):707–14.

    Article  PubMed  Google Scholar 

  8. Mackay MR, Ellis E, Johnston C. Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. Aust J Physiother. 2005;51(3):151–9.

    Article  PubMed  Google Scholar 

  9. Hall A, Older P. Cardiopulmonary exercise testing accurately predicts risk of major surgery including esophageal resection: letter 1. Ann Thorac Surg. 2009;87(2):670–1 (author reply 671-672).

    Article  PubMed  Google Scholar 

  10. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  PubMed  Google Scholar 

  11. Inoue J, Ono R, Makiura D, et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2013;26(1):68–74.

    Article  CAS  PubMed  Google Scholar 

  12. Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol. 2013;19(34):5598–606.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kojima S, Sakakibara H, Motani S, et al. Incidence of chronic obstructive pulmonary disease, and the relationship between age and smoking in a Japanese population. J Epidemiol. 2007;17(2):54–60.

    Article  PubMed  Google Scholar 

  14. Makiura D, Ono R, Inoue J, et al. Preoperative sarcopenia is a predictor of postoperative pulmonary complications in esophageal cancer following esophagectomy: a retrospective cohort study. J Geriatr Oncol. 2016;7(6):430–6.

    Article  PubMed  Google Scholar 

  15. Reeve JC, Nicol K, Stiller K, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Eur J Cardiothorac Surg. 2010;37(5):1158–66.

    Article  PubMed  Google Scholar 

  16. Nomori H, Kobayashi R, Fuyuno G, et al. Preoperative respiratory muscle training. Assessment in thoracic surgery patients with special reference to postoperative pulmonary complications. Chest. 1994;105(6):1782–8.

    Article  CAS  PubMed  Google Scholar 

  17. Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015;(10):CD010356.

Download references

Acknowledgements

The authors thank all the subjects who participated in this study. The authors are grateful to the surgeons, nurses, and staff of the Department of Rehabilitation Medicine at Nagasaki University Hospital.

Funding

This study did not receive special funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ryo Kozu.

Ethics declarations

Ethical statement

The Human Ethics Review Committee of Nagasaki University Hospital (Approval number: 13093051) approved this study. This work conforms to the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning human and animal rights. Also, the authors followed the policy concerning informed consent as shown.

Conflict of interest

All the authors declare that they have no conflict of interest regarding the subject of this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hanada, M., Kanetaka, K., Hidaka, S. et al. Effect of early mobilization on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery on the esophagus. Esophagus 15, 69–74 (2018). https://doi.org/10.1007/s10388-017-0600-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-017-0600-x

Keywords

Navigation