{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:00:07Z","timestamp":1753891207285,"version":"3.41.2"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 110-2314-B075B-005-MY2"],"award-info":[{"award-number":["MOST 110-2314-B075B-005-MY2"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Patients with lung cancer pose a high risk of morbidity and mortality after lung resection. Those who receive perioperative cardiopulmonary rehabilitation (PRCR) have better prognosis. Peak oxygen consumption (peak VO<jats:sub>2<\/jats:sub>), VO<jats:sub>2<\/jats:sub> at the ventilatory threshold (VO<jats:sub>2<\/jats:sub> at VT), and slope of minute ventilation to carbon dioxide production (V<jats:sub>E<\/jats:sub>\/V<jats:sub>CO2<\/jats:sub> slope) measured during pre-surgical cardiopulmonary exercise testing (CPET) have prognostic values after lung resection. We aimed to investigate the influence of individualized PRCR on postoperative complications in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer with different pre-surgical risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study. We recruited 125 patients who underwent VATS for lung cancer between 2017 and 2021. CPET was administered before surgery to evaluate the risk level and PRCR was performed based on the individual risk level defined by peak VO2, VO2 at VT, and VE\/VCO2 slope, respectively. The primary outcomes were intensive care unit (ICU) and hospital lengths of stay, endotracheal intubation time (ETT), and chest tube insertion time (CTT). The secondary outcomes were postoperative complications (PPCs), including subcutaneous emphysema, pneumothorax, pleural effusion, atelectasis, infection, and empyema.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three intergroup comparisons based on the risk level by peak VO2 (3 groups), VO2 at VT (2 groups), and VE\/VCO2 slope (3 groups) were done. All of the comparisons showed no significant differences in both the primary and secondary outcomes (<jats:italic>p<\/jats:italic> = 0.061\u20130.910).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with different risk levels showed comparable prognosis and PPCs after undergoing CPET-guided PRCR. PRCR should be encouraged in patients undergoing VATS for lung cancer.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.900165","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T05:42:15Z","timestamp":1655271735000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery"],"prefix":"10.3389","volume":"9","author":[{"given":"Wei-Hao","family":"Chao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng-Hui","family":"Tuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"En-Kuei","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Ju","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing-Hui","family":"Chung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guan-Bo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ko-Long","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin."},{"key":"B2","first-page":"56","article-title":"Lung cancer: diagnosis and management","volume":"75","author":"Collins","year":"2007","journal-title":"Am Fam Physician."},{"key":"B3","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.lungcan.2020.07.007","article-title":"Risk-based lung cancer screening: a systematic review","volume":"147","author":"Toumazis","year":"2020","journal-title":"Lung Cancer."},{"key":"B4","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/2047-0525-2-10","article-title":"Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study","volume":"2","author":"Goodyear","year":"2013","journal-title":"Perioper Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1111\/anae.12986","article-title":"Prediction of organ-specific complications following abdominal aortic aneurysm repair using cardiopulmonary exercise testing","volume":"70","author":"Barakat","year":"2015","journal-title":"Anaesthesia."},{"key":"B6","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1111\/bju.12895","article-title":"Cardiopulmonary reserve as determined by cardiopulmonary exercise testing correlates with length of stay and predicts complications after radical cystectomy","volume":"115","author":"Tolchard","year":"2015","journal-title":"BJU Int."},{"key":"B7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jpge.2015.02.001","article-title":"Pre-transplant aerobic capacity and prolonged hospitalization after liver transplantation","volume":"22","author":"Mancuzo","year":"2015","journal-title":"GE Port J Gastroenterol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1111\/hpb.12420","article-title":"Cardiopulmonary exercise testing for predicting postoperative morbidity in patients undergoing hepatic resection surgery","volume":"17","author":"Kasivisvanathan","year":"2015","journal-title":"HPB."},{"key":"B9","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1097\/ACO.0000000000000149","article-title":"Preoperative evaluation of the patient with lung cancer being considered for lung resection","volume":"28","author":"Choi","year":"2015","journal-title":"Curr Opin Anaesthesiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.ejcts.2008.11.004","article-title":"Exercise capacity assessment in patients undergoing lung resection","volume":"35","author":"Bobbio","year":"2009","journal-title":"Eur J Cardiothorac Surg."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1093\/eurheartj\/ehw180","article-title":"2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations","volume":"39","author":"Guazzi","year":"2018","journal-title":"Eur Heart J"},{"key":"B12","first-page":"1013","article-title":"Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection","volume":"28","author":"Kallianos","year":"2014","journal-title":"In Vivo"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1016\/j.athoracsur.2012.03.022","article-title":"Minute ventilation-to-carbon dioxide output (VE\/VCO2) slope is the strongest predictor of respiratory complications and death after pulmonary resection","volume":"93","author":"Brunelli","year":"2012","journal-title":"Ann Thorac Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ejcts.2010.01.032","article-title":"Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer","volume":"38","author":"Torchio","year":"2010","journal-title":"Eur J Cardiothorac Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1053\/j.seminoncol.2011.03.008","article-title":"Cancer rehabilitation","volume":"38","author":"Stubblefield","year":"2011","journal-title":"Semin Oncol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1213\/ANE.0000000000002497","article-title":"A review of opioid-sparing modalities in perioperative pain management: methods to decrease opioid use postoperatively","volume":"125","author":"Kumar","year":"2017","journal-title":"Anesth Analg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"9","DOI":"10.21037\/jovs.2017.12.11","article-title":"Anesthesia and analgesia: how does the role of anesthetists changes in the ERAS program for VATS lobectomy","volume":"4","author":"Piccioni","year":"2018","journal-title":"J Vis Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1183\/09031936.00184308","article-title":"ERS\/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)","volume":"34","author":"Brunelli","year":"2009","journal-title":"Eur Respir J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1378\/chest.126.3.942","article-title":"Cardiopulmonary exercise testing and prognosis in chronic heart failure: a prognosticating algorithm for the individual patient","volume":"126","author":"Corra","year":"2004","journal-title":"Chest."},{"key":"B20","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.lungcan.2008.12.024","article-title":"Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer","volume":"66","author":"Kasikcioglu","year":"2009","journal-title":"Lung Cancer."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1260","DOI":"10.1378\/chest.08-2059","article-title":"Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection","volume":"135","author":"Brunelli","year":"2009","journal-title":"Chest."},{"key":"B22","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1177\/1457496913509235","article-title":"Preoperative maximal oxygen uptake and exercise-induced changes in pulse oximetry predict early postoperative respiratory complications in lung cancer patients","volume":"103","author":"Fang","year":"2014","journal-title":"Scand J Surg."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1183\/09031936.00069910","article-title":"Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery","volume":"37","author":"Licker","year":"2011","journal-title":"Eur Respir J."},{"key":"B24","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1097\/JTO.0b013e318074bba7","article-title":"Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238","volume":"2","author":"Loewen","year":"2007","journal-title":"J Thorac Oncol."},{"key":"B25","first-page":"3089","article-title":"Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer","volume":"123","author":"Mao","year":"2010","journal-title":"Chin Med J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1177\/030089160409000408","article-title":"Preoperative evaluation of patients submitted to pneumonectomy for lung carcinoma: role of exercise testing","volume":"90","author":"Villani","year":"2004","journal-title":"Tumori."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1016\/S0012-3692(15)34462-7","article-title":"Cardiopulmonary exercise tests and lung cancer surgical outcome","volume":"127","author":"Win","year":"2005","journal-title":"Chest."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1007\/s00595-005-3078-4","article-title":"Expired gas analysis during exercise testing pre-pneumonectomy","volume":"35","author":"Nagamatsu","year":"2005","journal-title":"Surg Today."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1016\/j.athoracsur.2016.05.070","article-title":"Resting end-tidal carbon dioxide predicts respiratory complications in patients undergoing thoracic surgical procedures","volume":"102","author":"Brat","year":"2016","journal-title":"Ann Thorac Surg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.lungcan.2018.10.003","article-title":"Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection","volume":"125","author":"Miyazaki","year":"2018","journal-title":"Lung Cancer."},{"key":"B31","article-title":"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","volume-title":"Chest.","author":"Brunelli","year":"2013"},{"key":"B32","doi-asserted-by":"publisher","first-page":"A22","DOI":"10.1186\/1939-4551-8-S1-A22","article-title":"Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection","volume":"8","author":"Syrigos","year":"2015","journal-title":"World Allergy Organ J"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e001121","DOI":"10.1136\/bmjresp-2021-001121","article-title":"ARTP statement on cardiopulmonary exercise testing 2021","volume":"8","author":"Pritchard","year":"2021","journal-title":"BMJ Open Respir Res."},{"key":"B34","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s12630-014-0307-6","article-title":"Cardiopulmonary exercise testing, prehabilitation, and enhanced recovery after surgery (ERAS)","volume":"62","author":"Levett","year":"2015","journal-title":"Can J Anesth."},{"key":"B35","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.bja.2017.10.020","article-title":"Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation","volume":"120","author":"Levett","year":"2018","journal-title":"Br J Anaesth."},{"key":"B36","doi-asserted-by":"publisher","first-page":"3","DOI":"10.2478\/pneum-2020-0001","article-title":"Cardiopulmonary exercise testing in thoracic surgery","volume":"69","author":"Pele","year":"2020","journal-title":"Pneumologia."},{"key":"B37","doi-asserted-by":"publisher","first-page":"S56","DOI":"10.1016\/S0169-5002(19)30180-1","article-title":"Pre-operative uptake of cardiopulmonary exercise test (CPET) in lung cancer surgery in Wolverhampton","volume":"127","author":"Zahid","year":"2019","journal-title":"Lung Cancer"},{"key":"B38","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1111\/1759-7714.12199","article-title":"Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: a study for 342 cases","volume":"6","author":"Gao","year":"2015","journal-title":"Thorac Cancer."},{"key":"B39","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1136\/hrt.2007.121558","article-title":"Cardiopulmonary exercise testing and its application","volume":"83","author":"Albouaini","year":"2007","journal-title":"Postgrad Med J."},{"key":"B40","doi-asserted-by":"publisher","first-page":"CD012020","DOI":"10.1002\/14651858.CD012020.pub2","article-title":"Preoperative exercise training for patients with non-small cell lung cancer","volume":"6","author":"Cavalheri","year":"2017","journal-title":"Cochrane Database Syst Rev."},{"key":"B41","doi-asserted-by":"publisher","first-page":"7120","DOI":"10.1245\/s10434-021-10251-3","article-title":"Preoperative cardiopulmonary exercise test associated with postoperative outcomes in patients undergoing cancer surgery: a systematic review and meta-analyses","volume":"28","author":"Steffens","year":"2021","journal-title":"Ann Surg Oncol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1093\/ejcts\/ezw127","article-title":"Ventilatory efficiency slope: an additional prognosticator after lung cancer surgery","volume":"50","author":"Brunelli","year":"2016","journal-title":"Eur J Cardiothorac Surg."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.900165\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T05:42:21Z","timestamp":1655271741000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.900165\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,15]]},"references-count":42,"alternative-id":["10.3389\/fmed.2022.900165"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.900165","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2022,6,15]]},"article-number":"900165"}}