Would lung cancer patients benefit from prehabilitation before surgery? Selecting optimisable patient variables

Introduction: Studies have shown that prehabilitation for lung cancer patients undergoing lung resection can improve pulmonary function and postoperative outcomes. The extent to which preoperative pulmonary function itself contributes to postoperative length of stay (LOS) in these patients in unclear. Aim: To evaluate whether parameters which are potentially optimisable through a prehabilitation programme such as FEV1 and ECOG performance status (PS) influence LOS after surgery and the risk of postoperative complications (POC). We hypothesised that patients with a worse PS or FEV1 would require a longer LOS and have a higher POC rate. Methods: Data was prospectively collected from 282 lung cancer patients undergoing lung resection at Guy’s Hospital from July 2015 to September 2018 and analysed retrospectively. Patients were categorised based on PS. ANOVA and Chi-squared test were used to compare the mean postoperative LOS and prevalence of POC across the PS groups. The contribution of preoperative FEV1 to post-operative LOS was assessed using Pearson’s correlation. Results: POC occurred in 25.7%, 39.5% and 48.7% of patients in groups PS0, PS1 and PS2, respectively (p=0.019). Mean postoperative LOS was 5.76, 7.99 and 10.31 days for groups PS0, PS1 and PS2, respectively (p=0.001). The correlation between FEV1 and LOS was found to be weak but statistically significant (r=-0.14, 95% CI -0.25 to -0.02, p=0.0176). Conclusions: Poor PS is associated with worse post-surgical outcomes. FEV1 has a limited influence on postoperative LOS. The extent to which PS can be optimised through physical therapy remains to be determined.