1000 Section - Comparative Efficacy of Perioperative Rehabilitation at Different Stages in Patients Undergoing Lung Resection: A Systematic Review and Network Meta-Analysis

There has been no cross-sectional comparison on therapeutic efficacies of perioperative rehabilitation among different stages for lung cancer (LC) patients undergoing lung resection. We conducted the network meta-analysis (NMA) to compare them.


Design:

We conducted a systematic review and NMA by searching seven databases (PubMed, Web of Science, PEDro, Embase, MEDLINE via Ovid, Scopus, and Cochrane CENTRAL) up to May 21, 2025. Eligible randomized controlled trials (RCTs) evaluated postoperative outcomes including the 6-minute walk test (6MWT), predicted percentage of forced expiratory volume in one second (FEV1pred%), predicted percentage of forced vital capacity (FVCpred%), anxiety, length of hospital stay, dyspnea, duration of chest tube use, and quality of life (QoL). Data were independently extracted by two reviewers and analyzed using RevMan5.4, R, and Stata 17. The study protocol was registered in PROSPERO (ID: CRD420251068249).


Results:

A total of 53 RCTs involving 5109 patients were included. Compared with standard care, early postoperative rehabilitation significantly improved postoperative FEVpred%(mean difference [MD]: 4.62; 95% credible interval [CrI]: 0.18 to 9.13; SUCRA: 68.7%) and 6MWT (MD: 49.56; 95% CrI: 23.09 to 77.92; SUCRA: 70.7%). Preoperative rehabilitation was most effective in improving 6MWT (MD: 82.43; 95% CrI: 34.99 to 136.60; SUCRA: 96.5%). No substantial heterogeneity or publication bias was identified.


Conclusion:

This study demonstrated that early postoperative rehabilitation yielded  significant improvement in postoperative FEV1pred%, while peroperative rehabilitation was most effective in enhancing postoperative 6MWT among patients undergoing lung resection.