Background Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). We evaluated whether enhanced recovery after surgery plus pulmonary rehabilitation was superior over enhanced recovery after surgery alone in reducing the incidence of postoperative PPCs and length of hospital stay. Methods In this pragmatic multicentre, randomised controlled, parallel-group clinical trial, eligible patients scheduled for video-assisted lung cancer surgery were randomly assigned (1:1) to either a newly developed programme that integrated preoperative and postoperative pulmonary rehabilitation components into a generic thoracic enhanced recovery after surgery pathway, or routine thoracic enhanced recovery after surgery. Primary outcome was the overall occurrence of PPCs within 2 weeks after surgery. Secondary outcomes were the occurrence of specific complications, time to removal of chest drain, and length of hospital stay (LOS). Results Of 428 patients scheduled for lung cancer surgery, 374 were randomised with 187 allocated to the experimental programme and 187 to control. Incidence of PPCs at 14 Days was 18.7% (35/187) in the experimental group and 33.2% (62/187) in the control group (intention-to-treat, unadjusted HR 0.524, 95% CI 0.347 to 0.792, p=0.002). Particularly, significant risk reduction was observed regarding pleural effusion, pneumonia and atelectasis. Time to removal of chest drain and LOS were not significantly reduced in the experimental group. Conclusions Adding pulmonary rehabilitation to enhanced recovery after surgery appears to be effective in reducing the incidence of PPCs, but not LOS. Standard integration of pulmonary rehabilitation into thoracic enhanced recovery after surgery is a promising approach to PPC prophylaxis. Trial registration number ChiCTR1900024646. Data are available from the corresponding authors upon reasonable request.

中文翻译：

---

加速康复外科联合肺康复对电视辅助肺癌手术后并发症的影响：一项多中心随机对照试验

背景 肺癌手术与术后肺部并发症 (PPC) 的高发率相关。我们评估了在减少术后 PPC 的发生率和住院时间方面，加速康复外科加肺康复是否优于单纯手术后加速康复。方法 在这项务实的多中心、随机对照、平行组临床试验中，计划接受视频辅助肺癌手术的符合条件的患者被随机分配 (1:1) 到一项新开发的计划中，该计划将术前和术后肺康复组成部分整合到一个通用的胸椎加速康复外科通路，或常规胸椎加速康复外科手术。主要结果是术后 2 周内 PPC 的总体发生率。次要结果是特定并发症的发生、胸腔引流管移除时间和住院时间 (LOS)。结果 在计划进行肺癌手术的 428 名患者中，374 名被随机分配，其中 187 名分配到实验计划，187 名分配到对照组。14 天时 PPC 的发生率在实验组中为 18.7% (35/187)，在对照组中为 33.2% (62/187)（意向性治疗，未调整的 HR 0.524，95% CI 0.347 至 0.792，p= 0.002）。特别是，观察到胸腔积液、肺炎和肺不张的风险显着降低。实验组的胸腔引流管移除时间和 LOS 没有显着减少。结论 将肺康复与术后加速康复相结合似乎可有效降低 PPC 的发生率，但对 LOS 无效。将肺康复标准整合到手术后胸部加速康复中是一种很有前途的 PPC 预防方法。试用注册号ChiCTR1900024646。可根据合理要求从相应的作者处获得数据。