Preoperative Physical Inactivity Affects the Postoperative Course of Surgical Patients with Lung Cancer

OBJECTIVE

Preoperative performance status is an important factor in thoracic surgery, but little is known about the effect of preoperative physical activity (PA) on the postoperative course. This study investigated the associations between preoperative PA and postoperative complications and clinical outcomes of lung cancer surgery.

METHODS

This prospective observational study included patients who underwent surgery for lung cancer at a single institution. PA was measured before hospitalization for 5 consecutive days and then after surgery until hospital discharge. The daily step count and time spent performing moderate intensity activity (> 3 metabolic equivalents) were measured with an accelerometer. We examined the correlations between PA and preoperative pulmonary function and physical fitness, and examined the relationship between postoperative complication and PA. Finally, a multivariate analysis was performed with pre-hospital PA as the dependent variable.

RESULTS

Forty-two patients were analyzed. Univariate analysis found no correlation between pre-hospital PA and preoperative pulmonary function, but found significant positive correlations between pre-hospital PA and time spent performing moderate intensity activity, in-hospital PA, preoperative 6-minute walk distance, and maximum gait speed (r > 0.5, p < 0.01). The nine patients who developed postoperative complications had significantly lower pre-hospital and postoperative step count than the patients with no complication (p = 0.04). Multiple regression analysis showed that pre-hospital PA was significantly associated with time spent performing moderate intensity activity, maximum gait speed, and postoperative complication.

CONCLUSIONS

Evaluation of pre-hospital PA is useful in predicting the postoperative course after lung cancer surgery.

Burden of cancer attributable to tobacco smoke in Japan in 2015

Tobacco is the greatest single cause of many non-communicable diseases, including cancer. We calculated the proportion of cancer incidence and mortality in 2015 attributable to tobacco smoking and exposure to secondhand smoke (SHS). Data on the prevalence of active smoking were derived from the 2005 Japanese National Health and Nutrition Survey by age group and gender. For SHS exposure prevalence, data from a nationwide cross-sectional survey from 2004-2005 were used. Based on standard formulas, population attributable fractions (PAFs) for each cancer causally associated with active smoking, namely the oral cavity and pharynx, esophagus, stomach, colon, rectum, liver, pancreas, nasal, larynx, lung, uterine cervix, kidney, renal pelvis and ureter, bladder, and acute myeloid leukemia, were calculated for each sex and age group and aggregated to obtain the PAF among total cancer incidence and mortality. For SHS exposure, PAFs for lung cancer and total cancer were calculated using the same method. For Japan in 2015, 145,765 new cancer cases and 72,520 cancer deaths, corresponding to a PAF of 15.2% for total cancer incidence and 19.6% for total cancer mortality, were attributable to active tobacco smoking. For SHS exposure, 0.5% of total cancer incidence and 0.7% of total cancer mortality in 2015 were attributable. Tobacco is still one of the major causes of cancer in Japan.