Clinical application of inspiratory muscle training in postoperative patients with esophageal cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

JI Yanli ¹ , YANG Mei ¹ , ZHENG E ¹ ,  CHE Guowei ²

1. West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHE Guowei, Email: cheguoweixw@126.com

Keywords：

Inspiratory muscle training; Esophageal cancer; Value of clinical application; Meta-analysis

DOI：

10.7507/1672-2531.202201099

Video：

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Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16^th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV₁%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV₁/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： JI Yanli, YANG Mei, ZHENG E, CHE Guowei. Clinical application of inspiratory muscle training in postoperative patients with esophageal cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(7): 799-804. doi: 10.7507/1672-2531.202201099 Copy

1.	Patel N, Benipal B. Incidence of esophageal cancer in the United States from 2001-2015: a United States cancer statistics analysis of 50 states. Cureus, 2018, 10(12): e3709.
2.	Zeng H, Zheng R, Zhang S, et al. Esophageal cancer statistics in China, 2011: estimates based on 177 cancer registries. Thorac Cancer, 2016, 7(2): 232-237.
3.	Cellini F, Manfrida S, Casà C, et al. Modern management of esophageal cancer: radio-oncology in neoadjuvancy, adjuvancy and palliation. Cancers (Basel), 2022, 14(2): 431.
4.	Lai Y, Li H, Tian L, et al. Baseball bat-like gastric tube for end-to-side oesophageal-gastric anastomosis decreased risks of anastomotic leakage after oesophagectomy for oesophageal cancer: a retrospective propensity score matched comparative study with 613 patients. Int J Surg, 2022, 98: 106227.
5.	Ma Y, Yao X, Li Z, et al. The role of vascular invasion and lymphatic invasion in predicting recurrent thoracic oesophageal squamous cell carcinoma. World J Surg Oncol, 2022, 20(1): 12.
6.	Wang YF, Xu SY, Wang Y, et al. Clinical significance of signet ring cells in surgical esophageal and esophagogastric junction adenocarcinoma: a systematic review and meta-analysis. World J Clin Cases, 2021, 9(35): 10969-10978.
7.	Chang SH, Patel N, Du M, et al. Trends in early-onset vs late-onset colorectal cancer incidence by race/ethnicity in the United States cancer statistics database. Clin Gastroenterol Hepatol, 2021, S1542-3565(21): 00817-X.
8.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
9.	Vromans RD, van Eenbergen MC, Geleijnse G, et al. Exploring cancer survivor needs and preferences for communicating personalized cancer statistics from registry data: qualitative multimethod study. JMIR Cancer, 2021, 7(4): e25659.
10.	Inoue T, Ito S, Kanda M, et al. Preoperative six-minute walk distance as a predictor of postoperative complication in patients with esophageal cancer. Dis Esophagus, 2020, 33(2): doz050.
11.	Kitagawa Y, Matsuda S. Prevention of postoperative pulmonary complication is desired to reduce mortality and improve long-term survival after esophagectomy for esophageal cancer. Ann Gastroenterol Surg, 2020, 4(5): 478-479.
12.	Paul G, Echterdiek F, Bohle W, et al. Vocal fold paralysis is a common complication in esophageal cancer patients with esophagorespiratory fistula. J Gastrointestin Liver Dis, 2020, 29(1): 11-17.
13.	Raftery NB, Murphy CF, Donohoe CL, et al. The complexity of defining postoperative pneumonia following esophageal cancer surgery: a spectrum of lung injury rather than a simple infective complication? Ann Surg, 2020. DOI: 10.1097/SLA.0000000000004546.
14.	Weiner P, Man A, Weiner M, et al. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. J Thorac Cardiovasc Surg, 1997, 113(3): 552-557.
15.	Dsouza FV, Amaravadi SK, Samuel SR, et al. Effectiveness of inspiratory muscle training on respiratory muscle strength in patients undergoing cardiac surgeries: a systematic review with meta-analysis. Ann Rehabil Med, 2021, 45(4): 264-273.
16.	Dettling DS, van der Schaaf M, Blom RL, et al. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. Physiother Res Int, 2013, 18(1): 16-26.
17.	van Adrichem EJ, Meulenbroek RL, Plukker JT, et al. Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study. Ann Surg Oncol, 2014, 21(7): 2353-2360.
18.	魏利娟, 马亚飞, 伍军, 等. 吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响. 中华物理医学与康复杂志, 2015, 37(1): 40-44.
19.	黄晓宇, 耿明飞, 周福有, 等. 吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响. 中华物理医学与康复杂志, 2017, 39(7): 539-542.
20.	Guinan EM, Forde C, O'Neill L, et al. Effect of preoperative inspiratory muscle training on physical functioning following esophagectomy. Dis Esophagus, 2019, 32(2): doy091.
21.	Valkenet K, Trappenburg JCA, Ruurda JP, et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg, 2018, 105(5): 502-511.
22.	邓颖, 姬静, 申利敏. 吸气肌训练联合情志护理在食管癌根治术患者中的应用. 齐鲁护理杂志, 2020, 26(2): 87-90.
23.	胡宝花. 心灵关怀及吸气肌训练对食管癌患者围手术期心理状态及心肺功能的影响. 河南医学研究, 2021, 30(10): 1906-1909.
24.	Pu CY, Batarseh H, Zafron ML, et al. Effects of preoperative breathing exercise on postoperative outcomes for patients with lung cancer undergoing curative intent lung resection: a meta-analysis. Arch Phys Med Rehabil, 2021, 102(12): 2416-2427.

1. Patel N, Benipal B. Incidence of esophageal cancer in the United States from 2001-2015: a United States cancer statistics analysis of 50 states. Cureus, 2018, 10(12): e3709.
2. Zeng H, Zheng R, Zhang S, et al. Esophageal cancer statistics in China, 2011: estimates based on 177 cancer registries. Thorac Cancer, 2016, 7(2): 232-237.
3. Cellini F, Manfrida S, Casà C, et al. Modern management of esophageal cancer: radio-oncology in neoadjuvancy, adjuvancy and palliation. Cancers (Basel), 2022, 14(2): 431.
4. Lai Y, Li H, Tian L, et al. Baseball bat-like gastric tube for end-to-side oesophageal-gastric anastomosis decreased risks of anastomotic leakage after oesophagectomy for oesophageal cancer: a retrospective propensity score matched comparative study with 613 patients. Int J Surg, 2022, 98: 106227.
5. Ma Y, Yao X, Li Z, et al. The role of vascular invasion and lymphatic invasion in predicting recurrent thoracic oesophageal squamous cell carcinoma. World J Surg Oncol, 2022, 20(1): 12.
6. Wang YF, Xu SY, Wang Y, et al. Clinical significance of signet ring cells in surgical esophageal and esophagogastric junction adenocarcinoma: a systematic review and meta-analysis. World J Clin Cases, 2021, 9(35): 10969-10978.
7. Chang SH, Patel N, Du M, et al. Trends in early-onset vs late-onset colorectal cancer incidence by race/ethnicity in the United States cancer statistics database. Clin Gastroenterol Hepatol, 2021, S1542-3565(21): 00817-X.
8. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
9. Vromans RD, van Eenbergen MC, Geleijnse G, et al. Exploring cancer survivor needs and preferences for communicating personalized cancer statistics from registry data: qualitative multimethod study. JMIR Cancer, 2021, 7(4): e25659.
10. Inoue T, Ito S, Kanda M, et al. Preoperative six-minute walk distance as a predictor of postoperative complication in patients with esophageal cancer. Dis Esophagus, 2020, 33(2): doz050.
11. Kitagawa Y, Matsuda S. Prevention of postoperative pulmonary complication is desired to reduce mortality and improve long-term survival after esophagectomy for esophageal cancer. Ann Gastroenterol Surg, 2020, 4(5): 478-479.
12. Paul G, Echterdiek F, Bohle W, et al. Vocal fold paralysis is a common complication in esophageal cancer patients with esophagorespiratory fistula. J Gastrointestin Liver Dis, 2020, 29(1): 11-17.
13. Raftery NB, Murphy CF, Donohoe CL, et al. The complexity of defining postoperative pneumonia following esophageal cancer surgery: a spectrum of lung injury rather than a simple infective complication? Ann Surg, 2020. DOI: 10.1097/SLA.0000000000004546.
14. Weiner P, Man A, Weiner M, et al. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. J Thorac Cardiovasc Surg, 1997, 113(3): 552-557.
15. Dsouza FV, Amaravadi SK, Samuel SR, et al. Effectiveness of inspiratory muscle training on respiratory muscle strength in patients undergoing cardiac surgeries: a systematic review with meta-analysis. Ann Rehabil Med, 2021, 45(4): 264-273.
16. Dettling DS, van der Schaaf M, Blom RL, et al. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. Physiother Res Int, 2013, 18(1): 16-26.
17. van Adrichem EJ, Meulenbroek RL, Plukker JT, et al. Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study. Ann Surg Oncol, 2014, 21(7): 2353-2360.
18. 魏利娟, 马亚飞, 伍军, 等. 吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响. 中华物理医学与康复杂志, 2015, 37(1): 40-44.
19. 黄晓宇, 耿明飞, 周福有, 等. 吸气肌训练对食管癌根治术后患者心肺功能及生活质量的影响. 中华物理医学与康复杂志, 2017, 39(7): 539-542.
20. Guinan EM, Forde C, O'Neill L, et al. Effect of preoperative inspiratory muscle training on physical functioning following esophagectomy. Dis Esophagus, 2019, 32(2): doy091.
21. Valkenet K, Trappenburg JCA, Ruurda JP, et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg, 2018, 105(5): 502-511.
22. 邓颖, 姬静, 申利敏. 吸气肌训练联合情志护理在食管癌根治术患者中的应用. 齐鲁护理杂志, 2020, 26(2): 87-90.
23. 胡宝花. 心灵关怀及吸气肌训练对食管癌患者围手术期心理状态及心肺功能的影响. 河南医学研究, 2021, 30(10): 1906-1909.
24. Pu CY, Batarseh H, Zafron ML, et al. Effects of preoperative breathing exercise on postoperative outcomes for patients with lung cancer undergoing curative intent lung resection: a meta-analysis. Arch Phys Med Rehabil, 2021, 102(12): 2416-2427.

Chinese Journal of Evidence-Based Medicine

Clinical application of inspiratory muscle training in postoperative patients with esophageal cancer: a meta-analysis

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