演題番号 : WS28-2
Rationale: Interventions in perioperative rehabilitation, such as assisted ambulation and pulmonary physiotherapy, but the outcomes are not clear
Cardiopulmonary exercise testing (CPX) and Shuttle walking test (SWT) are non-invasive, objective methods of assessing integrated response of the heart, lungs, and musculoskeletal system to incremental exercise. This study aimed to evaluate the impact of physical activity using CPX or SWT in patients who underwent a transthoracic esophagectomy.
34 patients who underwent a transthoracic esophagectomy were enrolled into the Enhanced recovery after surgery (ERAS) program that included early post-operative enteral nutrition and mobilization. Each patient was evaluated using CPX on both the day of an admission day (pre) and day of discharge (post). On the other hand, 22 patients were enrolled into this program using SWT.
The program was started on the first postoperative day (POD 1). Routine postoperative bronchoscopy for toileting sputum and mechanical bowel preparation (MBP) before surgery were only performed when considered to be necessary. Outcome metrics comprised peakVO2, peak workload, and anaerobic threshold (AT) in CPX, the distance in SWT.
Results: In CPX, PeakVO2 (mL/kg/min) was 21.9 ± 4.4 (pre) and 17.0 ± 3.7 (post) (p < 0.01). Peak workload (watt) was 101.8 ± 23.5 (pre) and 76.5 ± 22.0 (post) (p < 0.01). AT(mL/kg/min) was 12.6 ± 2.2 (pre) and 11.3 ± 1.7 (post) (p < 0.01). The rates of decrease for peak VO2 and workload were 26.4% and 24.9%, respectively. In SWT, 521.4m in preoperative status, 477.1m in postoperative month 6 (POM 6), and 491.4m in POM 12.
Physical activity on the day of discharge decreased by approximately 25% and 4.9 METS which was calculated based on peakVO2. This level is not limited in daily usual life, but not enough to keep quality of life. The data of SWT indicated about 94% in POM12 compared with preoperative status.