Scolaris Content Display Scolaris Content Display

Flow diagram of references identified, excluded, and included in review
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Figure 1

Flow diagram of references identified, excluded, and included in review

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.1 Risk of developing a postoperative pulmonary complication.
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Figure 4

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.1 Risk of developing a postoperative pulmonary complication.

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.2 Number of days patients needed an intercostal catheter.
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Figure 5

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.2 Number of days patients needed an intercostal catheter.

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.3 Postoperative length of hospital stay.
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Figure 6

Forest plot of comparison: 1 Intervention group versus control group, outcome: 1.3 Postoperative length of hospital stay.

Comparison 1 Intervention group versus control group, Outcome 1 Risk of developing a postoperative pulmonary complication.
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Analysis 1.1

Comparison 1 Intervention group versus control group, Outcome 1 Risk of developing a postoperative pulmonary complication.

Comparison 1 Intervention group versus control group, Outcome 2 Number of days patients needed an intercostal catheter.
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Analysis 1.2

Comparison 1 Intervention group versus control group, Outcome 2 Number of days patients needed an intercostal catheter.

Comparison 1 Intervention group versus control group, Outcome 3 Postoperative length of hospital stay.
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Analysis 1.3

Comparison 1 Intervention group versus control group, Outcome 3 Postoperative length of hospital stay.

Comparison 1 Intervention group versus control group, Outcome 4 Preoperative exercise capacity (6‐minute walk distance).
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Analysis 1.4

Comparison 1 Intervention group versus control group, Outcome 4 Preoperative exercise capacity (6‐minute walk distance).

Comparison 1 Intervention group versus control group, Outcome 5 Forced vital capacity (% pred).
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Analysis 1.5

Comparison 1 Intervention group versus control group, Outcome 5 Forced vital capacity (% pred).

Summary of findings for the main comparison. Preoperative exercise training compared to no exercise training for patients scheduled to undergo lung resection for non‐small cell lung cancer

Preoperative exercise training compared to no exercise training for patients scheduled to undergo lung resection for non‐small cell lung cancer

Patient or population: patients scheduled to undergo lung resection for non‐small cell lung cancer
Setting: the studies were based in the USA, China, Brazil, Turkey, and Italy.
Intervention: preoperative exercise training
Comparison: no exercise training

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no exercise training

Risk with preoperative exercise training

Number of patients who developed postoperative pulmonary complications

Study population

RR 0.33
(0.17 to 0.61)

158
(4 RCTs)

⊕⊕⊝⊝
LOW 1, 2

22 per 100

7 per 100
(4 to 13)

Number of days patients needed an intercostal catheter

The mean number of days patients needed an intercostal catheter in the control groups ranged from 7.4 to 8.8 days

The number of days patients needed an intercostal catheter in the intervention groups was, on average, 3.33 fewer days
(95% CI 5.35 to 1.3 fewer days)

38
(2 RCTs)

⊕⊕⊝⊝
LOW 1, 2

Postoperative length of hospital stay

The mean postoperative length of hospital stay in the control groups ranged from 9.7 to 12.2 days

The postoperative length of hospital stay in the intervention groups was, on average, 4.34 fewer days (95% CI 5.65 to 3.03 fewer days)

158
(4 RCTs)

⊕⊕⊝⊝
LOW 1, 2

Post‐intervention exercise capacity assessed with: 6‐minute walk distance (6MWD)

The mean post‐intervention exercise capacity in the control groups ranged from 340 to 434 metres in 6 minutes.

The post‐intervention exercise capacity in the intervention groups was, on average, 18.23 metres more
(95% CI 8.5 to 27.96 metres more)

81
(2 RCTs)

⊕⊕⊝⊝
LOW 1, 2

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Significant risk of bias across the studies

2 Small sample sizes across the studies, some with wide confidence intervals

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Summary of findings for the main comparison. Preoperative exercise training compared to no exercise training for patients scheduled to undergo lung resection for non‐small cell lung cancer
Table 1. Table 1. Results of included studies

Study

Results

Benzo 2011

Number of patients who developed a postoperative pulmonary complication:

Intervention group (IG): 3 of 9 (33%)

Control Group (CG): 5 of 8 (63%)

P = 0.23 (between‐group)

Number of days patients needed a chest tube:

IG: 4.3 ± 2.1 days

CG: 8.8 ± 5.3 days

P = 0.03 (between‐group)

Postoperative length of hospital stay:

IG: 6.3 ± 3.0 days

CG: 11.0 ± 6.3 days

P = 0.058 (between‐group)

Lai 2017

Number of patients who developed a postoperative pulmonary complication:

IG: 4 of 30 (13%)

CG: 11 of 30 (37%)

P = 0.037 (between‐group)

Postoperative length of hospital stay:

IG: 6.9 ± 4.4 days

CG: 10.7 ± 6.4 days

P = 0.01 (between‐group)

Exercise capacity: Six‐Minute Walk Distance (6MWD), in metres:

IG: 30 participants completed; CG: 30 participants completed;

Preoperative measurements: baseline and post‐intervention:

Mean ± standard deviation (SD): IG: 431.7 ± 102.8 m to 460.3 ± 93.6 m; CG: 434.5 ± 86.2 m to 443.9 ± 88.4 m

P = 0.029 (between‐group)

Morano 2013

Number of patients who developed a postoperative pulmonary complication:

IG: 2 of 12 (17%)

CG: 7 of 9 (78%)

P = 0.01 (between‐group)

Number of days patients needed a chest tube:

IG: 4.5 ± 2.9 days

CG: 7.4 ± 2.6 days

P = 0.03 (between‐group)

Postoperative length of hospital stay:

IG: 7.8 ± 4.8 days

CG: 12.2 ± 3.6 days

P = 0.04 (between‐group)

Exercise capacity: Six‐Minute Walk Distance (6MWD), in metres:

IG: 12 participants completed; CG: 12 participants completed;

Preoperative measurements: baseline and post‐intervention:

Mean ± standard deviation (SD): IG: 425.5 ± 85.3 m to 475 ± 86.5 m (P < 0.01); CG: 339.6 ± 107 m to 335 ± 107 m (P > 0.05)

P < 0.001 (between‐group)

Lung function:

(i) Forced expired volume in one second (FEV1; % predicted):

IG: 12 participants completed; CG: 12 participants completed;

Preoperative measurements: baseline and post‐intervention:

IG: 48.1 ± 13.9% to 54.8 ± 22.4% (P = 0.08); CG: 51.7 ± 9.8% to 58.8 ± 13.0% (P = 0.23)

Between‐group difference was not calculated

(ii) Forced vital capacity (FVC; % predicted):

IG: 12 participants completed; CG: 12 participants completed;

Preoperative measurements: baseline and post‐intervention:

Median (interquartile range): IG: 62.5% (49 to 71) to 76% (65 to 79.7); P = 0.02; CG: 62.5% (56 to 92) to 71% (63.2 to 89); P = 0.37

Between‐group difference was not calculated

Pehlivan 2011

Number of patients who developed a postoperative pulmonary complication:

IG: 1 of 30 (3%)

CG: 5 of 30 (17%)

P = 0.04 (between‐group)

Postoperative length of hospital stay:

IG: 5.4 ± 2.7 days

CG: 9.7 ± 3.1 days

P < 0.001 (between‐group)

Lung function:

(i) FEV1; % predicted:

IG: 30 participants completed; CG: 30 participants completed;

Preoperative measurements: change from baseline to post‐intervention:

IG: 15.84 ± 2.10%; CG: 9.92 ± 3.5%

P = 0.3 (between‐group)

(ii) FVC; % predicted:

IG: 30 participants completed; CG: 30 participants completed;

Preoperative measurements: baseline and post‐intervention:

IG: 19.26 ± 2.33%; CG: 16.3 ± 2.4%

P = 0.6 (between‐group)

Stefanelli 2013

Exercise capacity: Peak rate of oxygen uptake (VO2peak), in ml/kg/min:

IG: 20 participants completed; CG: 20 participants completed;

Preoperative measurements: baseline and post‐intervention:

IG: 14.9 ± 2.3 ml/kg/min to 17.8 ± 2.1 ml/kg/min; CG: 14.8 ± 1.4 ml/kg/min to 14.5 ± 1.2 ml/kg/min

P < 0.001 (between‐group)

Lung function:

FEV1; % predicted:

IG: 20 participants completed; CG: 20 participants completed;

Preoperative measurements: baseline and post‐intervention:

IG: 57.4 ± 19.1% to 59.8 ± 19.2%; CG: 57.6 ± 16.9% to 57.5 ± 17.0%

P > 0.05 (between‐group)

Intervention group (IG), Control Group (CG)

Figures and Tables -
Table 1. Table 1. Results of included studies
Comparison 1. Intervention group versus control group

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Risk of developing a postoperative pulmonary complication Show forest plot

4

158

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.17, 0.61]

2 Number of days patients needed an intercostal catheter Show forest plot

2

38

Mean Difference (IV, Fixed, 95% CI)

‐3.33 [‐5.35, ‐1.30]

3 Postoperative length of hospital stay Show forest plot

4

158

Mean Difference (IV, Fixed, 95% CI)

‐4.24 [‐5.43, ‐3.06]

4 Preoperative exercise capacity (6‐minute walk distance) Show forest plot

2

81

Mean Difference (IV, Fixed, 95% CI)

18.23 [8.50, 27.96]

5 Forced vital capacity (% pred) Show forest plot

2

84

Mean Difference (IV, Fixed, 95% CI)

2.97 [1.78, 4.16]

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Comparison 1. Intervention group versus control group