Table 5.

Selected Studies on Exercise Testing after Lung Cancer Resection Surgery

Postsurgical Time Point/Selected Study	Patient Population	Exercise Test/Instrument	Findings	other Findings
1 mo: Nagamatsu et al.44	164 patients (149 lobectomy, 5 bilobectomy, 5 pneumonectomy)	CPET	${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}max$ improved significantly to 88% (±19%) of the preoperative baseline	FEV1, FVC, and DLCO improved significantly to ~70% of baseline
1–3 mo: Brunelli et al.46	156 patients (144 lobectomy, 12 pneumonectomy)	SF-36 questionnaire	Physical scale was reduced compared with preoperative value at 1 mo (51 vs. 45, p < 0.0001), and recovered at 3 mo (51 vs. 52, P = 0.2)	Mental and social scores were unchanged after surgery compared with preoperative scores
1–3 mo: Brunelli et al.45	200 patients (180 lobectomy, 20 pneumonectomy)	SCT to estimate ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$	After lobectomy, ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ was unchanged at 1 mo (96% of preoperative value) and 3 mo (97%) After pneumonectomy, ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ significantly improved (p < 0.05) to 87% of preoperative value at 1 mo and 89% at 3 mo	After lobectomy, FEV1 and DLCO significantly improved (p < 0.005) to 80% and 82% of preoperative values, respectively at 1 mo, and 84% and 89% at 3 mo After pneumonectomy, FEV1 and DLCO significantly improved (p < 0.005) to 65% and 75% of preoperative values, respectively at 1 mo, and 66% and 80% at 3 mo
3–6 mo: Nugent et al.47	53 patients (13 pneumonectomy)	CPET	${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ was reduced by 28% (23.9 ± 1.5 vs. 17.2 ± 1.7 mL/kg/min, p < 0.01) in patients undergoing pneumonectomy (n = 13) but unchanged after thoracotomy alone (n = 13), wedge-resection (n = 13), and lobectomy (n = 14)	FEV1 and DLCO % predicted was significantly reduced (p < 0.05) by 26% and 30%, respectively, after pneumonectomy
3 and > 6 mo: Nezu et al.48	82 patients (62 lobectomy, 20 pneumonectomy)	CPET	After lobectomy, ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}max$ decreased significantly at 3 mo and improved after more than 6 mo but did not reach preoperative values After pneumonectomy ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}max$ decreased significantly at 3 mo and did not recover thereafter on average, ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}max$ decreased 13.3% after lobectomy and 28.1% after pneumonectomy	After lobectomy, FEV1 and VC decreased significantly at 3 mo and improved after more than 6 mo but did not reach preoperative values After pneumonectomy FEV1 and VC decreased significantly at 3 mo and did not recover thereafter
12 mo: Wang et al.49	28 patients (19 lobectomy, 5 pneumonectomy, 4 segmentectomy)	CPET	${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}max$ decreased significantly (p < 0.05) after pneumonectomy (by 20%) and lobectomy (by 12%), but not after segmentectomy on average, ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}max$ decreased significantly by 2.1 mL/kg/min (from 18.5 ± 4.0 to 16.3 ± 4.8 mL/kg/min, 11%)	FEV1 decreased significantly after pneumonectomy (by 23%), lobectomy (by 9%), and segmentectomy (by 10%) FVC decreased significantly after pneumonectomy (by 28%) and lobectomy (by 13%) but not segmentectomy DLCO decreased significantly after pneumonectomy (by 33%), lobectomy (by 22%), and segmentectomy (by 9%)
Minimum 5 years: Deslauriers et al.50	100 postpneumonectomy patients	6MWT	6MWD was 83 ± 17% of predictive values; 19 out of 91 patients had lower than expected normal values	Compared to preoperative values, FEV1 % predicted decreased significantly by 30%, FVC by 14%, and DLCO by 33% SPAP was mildly elevated at 36 ± 9 mm Hg; abnormal diaphragmatic motion detected in 88 patients; dyspnea was mild in 47 patients, moderate in 24 patients, and severe in 3 patients
Mean 5.5 ± 4.2 years: Vainshelboim et al.51	17 postpneumonectomy patients	CPET, 6MWT	${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}$ was 48 ± 17% of predicted (11.5 ± 3.3 mL/kg/min) 6MWD was 89 ± 25% of predicted (490 ± 15m)	FEV1 was 46 ± 14%, FVC 55 ± 13%, DLCO 53 ± 18% of predicted SPAP mildly elevated at 38 ± 12 mm Hg

6MWD, 6-minute walk distance; 6MWT, 6-minute walk test; CPET, cardiopulmonary exercise testing; D_LCO, diffusion capacity of the lung for carbon monoxide; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; SCT, stair-climbing test; SPAP, systolic pulmonary arterial pressure; VC, vital capacity; ${\dot{\mathrm{V}}}_{{\mathrm{O}}_2}\text{peak}/max$, peak/maximal oxygen consumption; mo, month.