Intensive long-term pulmonary rehabilitation program after oesophagectomy, a reflection

There is body of evidence regarding the efficacy of Pulmonary Rehabilitation (PR) in the comprehensive management of patients with respiratory disease, and PR programs are practiced worldwide. Positive results in terms of improvement in dyspnoea, exercise capacity and Quality of Life (QoL) are recognized in Chronic Obstructive Pulmonary Disease (COPD). However PR is beneficial in other forms of chronic respiratory diseases, like asthma, cystic fibrosis, restrictive thoracic disease etc. Moreover, PR is becoming a crucial component of the overall treating strategy in high risk surgical patients (i.e. lung volume reduction surgery [LVRS] and lung transplantation), and in the preand post-operative period of patients who are candidates or have undergone lung resection (LR) for Non-Small Cell Lung Cancer (NSCLC). Pulmonary function is commonly altered after surgery, particularly in patients with COPD, current o ex smokers, who have had chest or upper abdominal surgery. The physiological changes observed are directly related to anesthesia (general or regional) and to the type of incision and surgical technique employed, and are reflected by decreases in total pulmonary capacity and pulmonary volumes and by a parallel reduction of Pa02. These functional alterations are in turn implicated in the development of postoperative pulmonary complications (PPC), which are the main causes of morbidity and mortality among surgical patients. Therefore, the recovery of a good physical and respiratory function, the improvement of dyspnoea and quality of life are an important outcome in the postoperative management of these patients. Breathing exercises have commonly been used to increase pulmonary volumes and improve gas exchange and ventilation distribution. Diaphragmatic, segmental, and costal respiratory exercises, as well as sustained maximal inspiration, may alleviate surgically induced alterations such as