H. Johnson1, K. Wang1, A. Elkamel1, K. Durante1, P. Hsu1, P. Sridhar1, S. Worrell1 1University Of Arizona, Tucson, AZ, USA
Introduction:
Exercise has shown to improve patient outcomes and mitigate morbidity risks in surgery. However, these benefits have not been demonstrated in thoracic surgery. This study aims to analyze the effect of strenuous exercise on thoracic surgery outcomes and use of adjuvant treatments for lung resections in lung cancer patients.
Methods:
Retrospective data was collected from the EMR of all patients who underwent a lung resection surgery diagnosed as lung cancer at a single institution from January 2022 to May 2024. Patients were organized into two groups by level of activity, identified as either strenuous exercisers or moderate and non-exercisers. Patients were identified as strenuous exercisers if they self-reported regular high intensity activity including swimming, biking, and walking. Those who walked <3 miles a day or only completed activities of daily living were counted as moderate exercisers and grouped with non-exercisers. Perioperative outcomes and overall survival were analyzed to compare the two groups. Analysis was performed using the Analysis System (SAS) version 9.4 developed (SAS Institute, Cary, NC, 2023) R 4.1.0. For continuous variables, a Wilcoxon rank sum test was used to analyze the data and presented as the median (IQR) value. The Chi-squared test was used for categorical variable analysis and presented as frequency (%).
Results:
A total of 164 patients were identified, mean age was 69 with 68 (41.46%) females and 96 (58.5%) males. 16 patients were self-reported to be engaging in strenuous exercise. There were no significant differences between baseline comorbidities, type of surgery (wedge vs lobe), or surgical approach (robotic vs video assisted thoracoscopy vs open). Patients who participated in high intensity activity were found to have higher FEV1 as compared to those who were not active (100% vs 87%, p<0.016). From a pathological perspective, there were no significant differences in tumor size, location, or histology. Hospital length of stay (3 days range 2,4 days for both groups, p=0.35), chest tube duration (2 days, rage 1 to 3.5 days for both, p=0.36), air leak rates (18.7% (3/16) vs 30.4% (45/148), p=0.51), and mortality rates (0% (0/16) vs 4.7% (7/148), p=>0.99) were examined and no significant differences were observed. Strenuous exercisers were given adjuvant immunotherapy more often than moderate and non-exercisers (25% (4/16) vs 9.46% (14/148), p=0.03).
Conclusion:
Adjuvant immunotherapy is traditionally used with higher stage lung cancer patients with an increased risk for recurrence to improve overall survival. An increased use of immunotherapy without a concurrent increase in tumor size, spread, or invasive pathology in the strenuous exercisers was found. This could indicate an unnecessary overuse of additional therapies in exercising patients. Further studies of cancer stage and objective exercise activity in a larger sample size will be completed to better analyze this association.