Torasik Cerrahide Perioperatif Pulmoner Rehabilitasyon ve Fiziksel Manipülasyonun Etkinliği: Güncel Bir Derleme

Year 2026, Volume: 5 Issue: 1, 57 - 63, 24.03.2026

Şeyda Erçin , Ayfer Özbaş

https://doi.org/10.61830/balkansbd.1845615

https://izlik.org/JA89JJ65HB

Abstract

Torasik cerrahi girişimler sonrası gelişen pulmoner komplikasyonlar, morbidite, mortalite ve hastanede kalış süresini artıran önemli faktörlerdir. Pulmoner rehabilitasyon, torasik cerrahi hastalarında etkili ve stratejik bir perioperatif müdahaledir. Pulmoner rehabilitasyon; solunum egzersizleri, aerobik ve direnç egzersizleri, hasta eğitimi, erken mobilizasyon ve göğüs fizyoterapisi/manipülatif teknikleri kapsamaktadır. Sistematik derlemeler ve meta-analizler, özellikle düşük fonksiyonel kapasiteli ve yüksek riskli (KOAH'lı, sigara içicisi) hastalarda perioperatif pulmoner rehabilitasyonun etkinliğini desteklemektedir. Literatürde özellikle preoperatif dönemde uygulanan kısa süreli ancak hedeflenmiş pulmoner rehabilitasyon programlarının postoperatif pulmoner komplikasyonları anlamlı ölçüde azalttığını göstermektedir.
Bu derlemenin amacı, torasik cerrahide perioperatif pulmoner rehabilitasyon ve fiziksel/manipülatif uygulamaların etkinliğine ilişkin güncel literatürü değerlendirmektir.

Keywords

Torasik cerrahi , pulmoner rehabilitasyon , fizyoterapi

Ethical Statement

Bu çalışma bir derleme (literatür taraması) niteliğinde olduğundan, etik kurul onayı alınmasına gerek duyulmamıştır. Makalenin hazırlanma sürecinde bilimsel ve etik ilkelere sadık kalınmış, yararlanılan tüm kaynaklar kaynakça listesinde usulüne uygun olarak belirtilmiştir.

Supporting Institution

Bulunmamaktadır

Project Number

yoktur

Efficacy of Perioperative Pulmonary Rehabilitation And Physical Manipulation in Thoracic Surgery: A Current Review

https://izlik.org/JA89JJ65HB

Abstract

Pulmonary complications developing after thoracic surgical procedures are significant factors that increase morbidity, mortality, and length of hospital stay. Pulmonary rehabilitation is an effective and strategic perioperative intervention for thoracic surgery patients. Pulmonary rehabilitation encompasses breathing exercises, aerobic and resistance exercises, patient education, early mobilization, and chest physiotherapy/manipulative techniques. Systematic reviews and meta-analyses support the effectiveness of perioperative pulmonary rehabilitation, particularly in high-risk patients (those with COPD, smokers) and those with low functional capacity. The literature demonstrates that short-term but targeted pulmonary rehabilitation programs, especially when applied in the preoperative period, significantly reduce postoperative pulmonary complications. The aim of this review is to evaluate the current literature regarding the effectiveness of perioperative pulmonary rehabilitation and physical/manipulative interventions in thoracic surgery.

Keywords

Keywords: Thoracic surgery , pulmonary rehabilitation , physiotherapy

Ethical Statement

As this study is a review article based on literature, ethical committee approval was not required. The authors declare that the study was conducted in accordance with scientific and ethical guidelines, and all sources used have been properly cited.

Supporting Institution

none

Project Number

yoktur

References

• Ahmad, A. M. (2018). Essentials of physiotherapy after thoracic surgery: What physiotherapists need to know. A narrative review. Korean Journal of Thoracic and Cardiovascular Surgery, 51(5), 293- 307. https://doi.org/10.5090/kjtcs.2018.51.5.293
• American Thoracic Society. (1981). Pulmonary rehabilitation—1981. American Review of Respiratory Disease, 124(5), 663–666.
• Batchelor, T. J. P., Rasburn, N. J., AbdelnourBerchtold, E., Brunelli, A., Cerfolio, R. J., Gonzalez, M., Ljungqvist, O., Petersen, R. H., Popovic, W. M., Sriswaj, P. I., & Szoka, K. (2019). Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). European Journal of Cardio-Thoracic Surgery, 55(1), 91–115. https://doi.org/10.1093/ejcts/ezy301
• Brunelli, A., Falcoz, P. E., Daddi, M., Pugh, A., Salati, M., Rocco, F., & Varela, G. (2009). European guidelines on structure and qualification of general thoracic surgery. European Journal of Cardio-Thoracic Surgery, 36(5), 797-801. https://doi.org/10.1016/j.ejcts.2009.04.053
• Candia, C., Maniscalco, L., Fuschillo, S., Spanevello, A., & Visca, D. (2025). The history of pulmonary rehabilitation: Learning from the past to shape a brighter future. Breathe, 21(3), 250171. https://doi.org/10.1183/20734735.0171-2025
• Fernandez-Bustamante, A., Frendl, G., Sprung, J., Kor, D. J., Subramaniam, B., Martinez-Palli, G., & Colgan, S. P. (2017). Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: A multicenter study. Anesthesiology, 127(5), 899– 911. https://doi.org/10.1097/ALN.0000000000001853
• Ge, X., Wang, W., Hou, L., Yang, K., Fa, S., & Jiang, M. (2019). The role of preoperative inspiratory muscle training in lung cancer patients: A systematic review and meta-analysis. European Journal of Surgical Oncology, 45(11), 2063-2069. https://doi.org/10.1016/j.ejso.2019.06.035
• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2024). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease (2024 Report). https://goldcopd.org/2024-goldreport-2/ Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2025). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2025 report. https://goldcopd.org/2025-gold-report/
• Holland, A. E., Cox, N. S., Houchen-Wolloff, L., Rochester, C. L., Garvey, C., ZuWallack, R., Nici, L., Limberg, T., Lareau, S. C., Troosters, T., Halkritter, R., Casaburi, R., Clini, E. M., Goldstein, R. S., Lafferty, K., Patino, C. M., Patten, S. J., Pitta, F., Ries, A. L., ... Singh, S. J. (2021). Defining modern pulmonary rehabilitation. An official American Thoracic Society workshop report. Annals of the American Thoracic Society, 18(5), e12-e29. https://doi.org/10.1513/AnnalsATS.202102- 146ST
• Houchen-Wolloff, L., & Singh, S. J. (2024). Pulmonary rehabilitation: 2023 and beyond. The Lancet Respiratory Medicine, 12(1), e2- e3. https://doi.org/10.1016/S2213- 2600(23)00412-6
• Kaufhold-Wastlhuber, S., Passauer-Baierl, S., Bernasconi, M., & Ried, M. (2025). Priorities and strategy for the implementation of enhanced recovery after surgery (ERAS) in thoracic surgery. Journal of Thoracic Disease, 17(3), 1-10. https://doi.org/10.21037/jtd-24- 114
• Li, J., Wang, H., Wang, J., Zhang, Y., Liu, X., & Chen, L. (2024). Effectiveness of refined nursing intervention on postoperative recovery and respiratory function in lung cancer patients after thoracic surgery. Medicine (Baltimore), 103(44), e40050. https://doi.org/10.1097/MD.00000000000400 50
• Li, Q., Li, X., Zhang, Y., & Chen, H. (2025). Incidence and risk factors of postoperative pulmonary complications following esophageal cancer surgery: A single-center retrospective study. Thoracic Cancer, 1–10. https://doi.org/10.1111/1759-7714.15123 Trakya University Balkan Health Science Journal,5(1),89-95,2026 95
• Lim, E., Baldwin, D., Beckles, M., Duffy, J., Entwisle, J., Faivre-Finn, C., Kerr, K., Macfie, A., McGuigan, J., Padley, S., & Popat, S. (2022). British Thoracic Society guidelines on the management of early-stage non-small cell lung cancer. Thorax, 77(Suppl 1), i1–i54. https://doi.org/10.1136/thoraxjnl-2022- 218968
• Mainini, C., Rebelo, P. F., Bardelli, R., Kopliku, B., Tenconi, S., Costi, S., Tedeschi, C., & Fugazzaro, S. (2016). Preoperative physical exercise intervention for patients undergoing lung cancer surgery: A systematic review. Surgical Oncology, 25(3), 272-279. https://doi.org/10.1016/j.suronc.2016.05.016
• Önerup, A., Bock, D., Börjesson, M., Fagevik Olsén, M., & Westerdahl, E. (2020). Is preoperative physical performance associated with postoperative complications in patients undergoing lung cancer surgery? European Journal of Cardio-Thoracic Surgery, 58(3), 560–567. https://doi.org/10.1093/ejcts/ezaa020
• Petty, T. L., Nett, L. M., Finigan, M. M., Brink, G. A., & Corsello, P. R. (1969). A comprehensive care program for chronic airway obstruction: Methods and preliminary evaluation of symptomatic and functional improvement. Annals of Internal Medicine, 70(6), 1109–1120. https://doi.org/10.7326/0003-4819-70-6-1109
• Racca, V., Bordoni, B., Castiglioni, P., Modica, M., & Ferratini, M. (2023). Osteopathic manipulative treatment in patients undergoing thoracic surgery: A randomized controlled trial. Journal of Thoracic Disease, 15(1), 171- 180. https://doi.org/10.21037/jtd-22-1088
• Rochester, C. L., Alison, J. A., Carlin, B., Jenkins, A. R., Cox, N. S., Bauldoff, G., Bhatt, S. P., Bourbeau, J., Burtin, C., Camp, P. G., ... & Holland, A. E. (2023). Pulmonary rehabilitation for adults with chronic respiratory disease: An official American Thoracic Society clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 208(4), e7-e26.https://doi.org/10.1164/rccm.202306-1066ST
• Rokah, M., & Ferri, L. (2025). Implementation of enhanced recovery after surgery program for lung resection. Current Challenges in Thoracic Surgery, 7, 1-12. https://doi.org/10.21037/ccts23-14
• Sanchez-Lorente, D., Navarro-Ripoll, R., Guzman, R., Moises, J., Gimeno, E., Boada, M., & Molins, L. (2020). ERAS guidelines for thoracic surgery. Journal of Thoracic Disease, 12(6), 3354-3360. https://doi.org/10.21037/jtd.2020.04.14
• Siegel, R. L., Giaquinto, A. N., & Jemal, A. (2024). Cancer statistics, 2024. CA: A Cancer Journal for Clinicians, 74(1), 12-49. https://doi.org/10.3322/caac.21820
• Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D., ... & Wouters, E. F. (2013). An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine, 188(8), e13-e64. https://doi.org/10.1164/rccm.201309-1634ST
• Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
• Volsko, T. A. (2023). Airway clearance therapy: Finding the evidence. Respiratory Care, 68(10), 1409–1426. https://doi.org/10.4187/respcare.11303
• Wang, Q., Liu, Z., Qi, L., & Gao, R. (2026). Effects of pulmonary rehabilitation in people with lung cancer after lung resection: A systematic review and meta-analysis. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-025-01758-0
• Zhang, Y., & Wang, L. (2025). A study on the application and effect of ERAS-based refined nursing in patients undergoing radical lung cancer surgery. Frontiers in Surgery, 12, 1557289. doi:10.3389/fsurg.2025.1557289