Enhanced Postoperative Recovery May Improve Outcomes in Elderly NSCLC

Postoperative pulmonary complications were reduced with enhanced recovery after surgery vs control in elderly patients with non–small cell lung cancer.

Using an enhanced recovery after surgery (ERAS) model following thoracoscopic surgery may enhance postoperative outcomes for elderly patients with non–small cell lung cancer compared with traditional recovery methods, according to results from a randomized control study published in the Journal of The Society of Laparoscopic & Robotic Surgeons.

Findings from the trial revealed that the incidence of postoperative pulmonary complications was significantly reduced with ERAS use, with only 8 of 100 (8%) of patients in the ERAS group experiencing them vs 18 of 100 (18%) in the control group (P = .036). Additionally, ERAS use was associated with 4 instances of pulmonary infection vs 6 with standard of care (SOC; P = .516), as well as 2 and 10 atelectasis instances, respectively (P = .017).

Furthermore, postoperative drainage was significantly shorter with ERAS, taking a median of 2.57 ± 0.72 days vs 3.92 ± 1.54 days with SOC (P = .000). Postoperative pain score was also significantly lower at 2.14 ± 0.86 points with ERAS vs 3.78 ± 1.15 points with SOC (P = .017).

“We fully considered the current situation of patients in this region and developed a series of perioperative measures for ERAS to investigate the effects of ERAS on the incidence of postoperative pulmonary complications, postoperative drainage, postoperative pain, pulmonary function on postoperative day 7 and postoperative hospital stay among elderly patients with lung cancer,” Zhihai Wang, MD, researcher at the Department of Thoracic and Cardiovascular Surgery of Wuhu Hospital in China, wrote in the publication with study coinvestigators. “We found that the incidence of postoperative pulmonary complications in the ERAS group was significantly lower than that in the control group.”

The 200 patients enrolled on trial were admitted and received thoracoscopic surgery from January 1, 2020, to December 31, 2021. They were subsequently randomly assigned 1:1 to the ERAS group or control group. No significant differences in sex, age, tumor location, smoking status, duration of surgery and surgery status were observed between arms.

Patients in the ERAS group were given a homemade simple respiratory function exerciser and employed pursed lip abdominal breathing and respiratory gymnastics. Additionally, patients in this cohort received a strict 6-hour fasting regimen with at least 2 hours of no water prior to surgery. Additionally, in the intraoperative phase for the ERAS group, the effective ventilation volume was increased, intraoperative body temperature protection was performed by an insulation blanket, intraoperative fluid supply was controlled, and no indignant catheter was placed if the estimated anesthetic time was less than 4 hours.

By contrast, patients in the control group were assigned the active cycle of breathing technique (ACBT) sputum discharge method and balloon-blowing exercises, as well as traditional fasting and intraoperative surgical condition approaches. Both groups received preoperative education regarding recovery, postoperative pain, and analgesia, and postoperative analgesia was performed.

The study end points were postoperative pulmonary complication occurrence, postoperative drainage time, postoperative pain score, and pulmonary function assessed through forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) on postoperative day 7.

Additional data from the trial showed significantly improved FVC on postoperative day 7 in the ERAS group, with a score of 2.41 ± 0.66 vs 2.05 ± 0.58 in the control group (P = .000). Additionally, FEV1 on postoperative day 7 was also significantly improved with ERAS: 2.14 ± 0.55 vs 1.77 ± 0.42 with SOC (P = .000).

Reference

Wang Z, Lin M, Geng G, Wu W, Tao Y. Application of enhanced recovery after surgery in the perioperative period for elderly patients with lung cancer. JSLS. 2025;28(3):e2024.00037 doi:10.4293/JSLS.2024.00037