[en] INTRODUCTION: Lung resection surgery (LRS) remains the treatment of choice for early stages of lung cancer but significant morbidity is associated, especially among patients with poor preoperative status. Preoperative exercise training (PET) has been proposed as an effective way of optimizing patients' condition before surgery and enhancing postoperative recovery. However, it remains unknown whether or not similar results can be achieved after video-assisted thoracic surgery (VATS). Therefore, the aim of this thesis is to determine the feasibility, safety and efficacy of a preoperative pulmonary rehabilitation program (PPRP) on the functional and postoperative outcomes on patients undergoing VATS. MATERIALS AND METHODS: This thesis was structured in three studies: 1) a systematic review and meta-analysis of the effects PET on the functional and postoperative outcomes after LRS; 2) a small pilot investigation to assess the feasibility, safety and preliminary effects of a PPRP in patients awaiting VATS; and 3) a randomized controlled trial examining the effects of the PPRP after VATS for lung cancer on selected postoperative and functional outcomes in comparison to the standard care. RESULTS: Results from the study #1 show that PET improves pulmonary function before surgery and hastens postoperative recovery by reducing postoperative complications and hospital length of stay. In study #2, we concluded that a PPRP is safe and feasible and can potentially improve functional fitness. Finally, study #3, confirmed that a PPRP significantly improves exercise capacity, muscle strength and health-related quality of life while minimizing the impact of LRS during the first 3 months after VATS. CONCLUSIONS: We conclude that preoperative exercise-based interventions in patients with lung cancer awaiting VATS are feasible, safe and can significantly improve exercise and functional performance and enhance postoperative recovery.

[gl] INTRODUCCION: A cirurxía de resección pulmonar (CRP) constitue o tratamiento de elección en pacientes con cancro de pulmón en estadios iniciáis pero a morbilidade asociada continua a ser elevada especialmente en pacientes con peor condición física de base. Neste contexto, a Rehabilitación Pulmonar Preoperatoria (PRP) podería considerarse como unha ferramenta útil para disminuir o risco quirúrxico e optimizar o estado funcional dos pacientes. Non obstante, desconecese o rol destos programas nos pacientes operados por videocirurxía. Así pois, o obxectivo desta tese de doutoramento e estudar a viabilidade, seguridade e eficacia da Rehabilitación Pulmonar Preoperatoria (RPP) en pacientes con cancro de pulmón sometidos a resección pulmonar por videocirurxía. MATERIAL E METODOS: Esta tese está estructurada en tres estudos: 1) revisión sistemática e meta-analice da efectividade da RPP en pacientes con cancro de pulmón sometidos a CRP para mellorar o estado funcional e acelerar a recuperación postoperatoria; 2) estudo piloto sobre a viabilidade, seguridade e eficacia preliminar da RPP en pacientes operados por videocirurxía e 3) ensaio clínico aleatorizado sobre o impacto da RPP sobre a tolerancia o esforzo, a capacidade funcional e a tolerancia o esforzo no postoperatorio de CRP en comparación co tratamento estándar. RESULTADOS: Os resultados obtidos no estudo #1 mostraron que o exercicio preoperatorio en pacientes sometidos a CRP mellora a función pulmonar e acelera a recuperación postoperatoria ao reducir o número de complicacións postoperatorias e a estadía hospitalaria; no estudo #2 quedo comprobada a viabilidade da intervención así como a ausencia de eventos adversos así como o potential da intervención para mellorar a funcionalidade dos pacientes; finalmente, o estudo #3 corroborou a efectividade da RPP para optimizar o estado funcional v | P a g e dos pacientes previo a cirurxía e disminuir o impacto ocasionado pola CRP durante os tres primeiros meses tras videocirurxía. CONCLUSIÓNS: A RPP en pacientes con cancro de pulmón sometidos a videocirurxía e viable, segura e eficaz para incrementar a tolerancia o estado funcional previo a cirurxía e optimizar a recuperación postoperatoria.