New strategy of postoperative comprehensive rehabilitation for elderly patients with lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Nanxi ¹ , WANG Jiao ^2,3,4 , XU Lin ^2,3,4 , LUO Zeruxin ^2,3,4 ,  YU Pengming ^2,3,4

1. School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

YU Pengming, Email: 13438201451@126.com

Keywords：

Aging; lung cancer; postoperative rehabilitation; enhanced recovery after surgery; digital health

DOI：

10.7507/1007-4848.202508004

Video：

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[Abstract ]With the increasing incidence of lung cancer in the elderly, how to improve the quality and speed of postoperative recovery on the basis of ensuring the therapeutic effect has become an important issue in surgical management. The postoperative recovery process of elderly patients with lung cancer shows higher complexity and challenge due to their unique frailty, comorbidity burden and treatment response. This article will focus on the postoperative rehabilitation strategy, systematically sort out the physiological, pathological and treatment response characteristics of postoperative recovery in elderly patients with lung cancer, propose five postoperative rehabilitation intervention modules based on the enhanced recovery after surgery concept, and further integrate the three challenges of insufficient compliance, research heterogeneity and health economic barriers, and propose a breakthrough method with precise rehabilitation and digital management as the core, providing theoretical support and practical guidance for the optimization and implementation of postoperative rehabilitation programs for elderly patients with lung cancer.

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37.	Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, et al. Perioperative nutritional support: a review of current literature. Nutrients, 2022, 14(8): 1601.
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1. Stieglitz S, Goede V, Schlesinger A. Management of lung cancer in older adults. Z Gerontol Geriatr, 2025, 58(2): 103-108.
2. 中华医学会肿瘤学分会. 中华医学会肺癌临床诊疗指南 (2024版). 中华医学杂志, 2024, 104(34): 3175-3213.Chinese Society of Oncology, Chinese Medical Association. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 edition). Natl Med J China, 2024, 104(34): 3175-3213.
3. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
4. Shirvani SM, Jiang J, Chang JY, et al. Lobectomy, sublobar resection, and stereotactic ablative radiotherapy for early-stage non-small cell lung cancers in the elderly. JAMA Surg, 2014, 149(12): 1244-1253.
5. Kim DH, Rockwood K. Frailty in older adults. N Engl J Med, 2024, 391(6): 538-548.
6. Handforth C, Clegg A, Young C, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol, 2015, 26(6): 1091-1101.
7. Yuan S, Larsson SC. Epidemiology of sarcopenia: prevalence, risk factors, and consequences. Metabolism, 2023, 144: 155533.
8. Zhou H, Zheng Z, Fan C, et al. Mechanisms and strategies of immunosenescence effects on non-small cell lung cancer (NSCLC) treatment: a comprehensive analysis and future directions. Semin Cancer Biol, 2025, 109: 44-66.
9. Song Y, Luo Y, Zhang F, et al. Systemic immune-inflammation index predicts postoperative delirium in elderly patients after surgery: a retrospective cohort study. BMC Geriatr, 2022, 22(1): 730.
10. Salive ME. Multimorbidity in older adults. Epidemiol Rev, 2013, 35: 75-83.
11. Mohamed MR, Ramsdale E, Loh KP, et al. Associations of polypharmacy and inappropriate medications with adverse outcomes in older adults with cancer: a systematic review and meta-analysis. Oncologist, 2020, 25(1): e94-e108.
12. Edwards BJA, Khalil P, Holmes HM, et al. Cognitive impairment and dementia in older cancer patients. J Clin Oncol, 2016, 34(3): e269.
13. Sugimoto T, Arai H, Sakurai T. An update on cognitive frailty: its definition, impact, associated factors and underlying mechanisms, and interventions. Geriatr Gerontol Int, 2022, 22(2): 99-109.
14. Wang X, Ma X, Yang M, et al. Proportion and related factors of depression and anxiety for inpatients with lung cancer in China: a hospital-based cross-sectional study. Support Care Cancer, 2022, 30(6): 5539-5549.
15. Gonzalez-Ling A, Galindo Vázquez O, Rascón-Gasca ML, et al. Dignity therapy in Mexican lung cancer patients with emotional distress: impact on psychological symptoms and quality of life. Palliat Support Care, 2022, 20(1): 62-68.
16. Shin S, Kong S, Kang D, et al. Longitudinal changes in pulmonary function and patient-reported outcomes after lung cancer surgery. Respir Res, 2022, 23(1): 224.
17. Kaprin A, Pikin O, Ryabov A, et al. Surgical intervention for lung cancer in patients aged 75 and above: potential associations with increased mortality rates-a single-center observational study. J Cardiothorac Surg, 2024, 19(1): 471.
18. Zhang Z, Yang W, Wang L, et al. Unraveling the role and mechanism of mitochondria in postoperative cognitive dysfunction: a narrative review. J Neuroinflammation, 2024, 21(1): 293.
19. Cottrell JE, Hartung J. Anesthesia and cognitive outcome in elderly patients: a narrative viewpoint. J Neurosurg Anesthesiol, 2020, 32(1): 9-17.
20. Blum SM, Rouhani SJ, Sullivan RJ. Effects of immune-related adverse events (irAEs) and their treatment on antitumor immune responses. Immunol Rev, 2023, 318(1): 167-178.
21. Basavaraj A, Choate R, Addrizzo-Harris D, et al. Airway clearance techniques in bronchiectasis: analysis from the United States bronchiectasis and non-TB mycobacteria research registry. Chest, 2020, 158(4): 1376-1384.
22. Xu Z, Chen Y, Zhang Z, et al. Feasibility of postoperative home-based pulmonary function training for lung cancer patients: a real-world study. J Cardiothorac Surg, 2025, 20(1): znae045.
23. Seixas MB, Almeida LB, Trevizan PF, et al. Effects of inspiratory muscle training in older adults. Respir Care, 2020, 65(4): 535-544.
24. Wang JQ, Ma ZJ. Impact of video-assisted thoracic surgery versus open thoracotomy on postoperative wound infections in lung cancer patients: a systematic review and meta-analysis. BMC Pulm Med, 2025, 25(1): 159.
25. 中国老年保健协会肺癌专业委员会, 四川省康复医学会加速康复外科分会, 成都康复医学会肺康复专业委员会, 等. 肺癌围手术期肺康复训练中国专家共识. 中国肺癌杂志, 2024, 27(7): 495-503.Lung Cancer Professional Committee of China Geriatric Health Association, Enhanced Recovery After Surgery Branch of Sichuan Rehabilitation Medical Association, Pulmonary Rehabilitation Professional Committee of Chengdu Rehabilitation Medical Association, et al. Chinese Expert Consensus on Perioperative Pulmonary Rehabilitation Training for Lung Cancer. Chin J Lung Cancer, 2024, 27(7): 495-503.
26. Unaldi HE. Effects of mobilization within the first 4 h following anatomical lung resection with thoracotomy. Updates Surg, 2023, 75(7): 2027-2031.
27. Raz DJ, Kim JY, Erhunwmunesee L, et al. The value of perioperative physical activity in older patients undergoing surgery for lung cancer. Expert Rev Respir Med, 2023, 17(8): 691-700.
28. Koll TT, Semin JN, Grieb BM, et al. Motivating older adults with cancer to keep moving: the implications of lifestyle interventions on physical activity. Curr Oncol Rep, 2017, 19(10): 68.
29. Shen Q, Sherwood GD, McNeill JA, et al. Postoperative pain management outcome in Chinese inpatients. West J Nurs Res, 2008, 30(8): 975-990.
30. Zhang YE, Xu X, Gong R. Postoperative pain management outcomes at a Chinese hospital: a cross-sectional survey. J Perianesth Nurs, 2023, 38(3): 434-439.
31. Gupta AK, Mena S, Jin Z, et al. Postoperative pain: a review of emerging therapeutic options. Expert Rev Neurother, 2021, 21(10): 1085-1100.
32. Del Tedesco F, Sessa F, Xhemalaj R, et al. Perioperative analgesia in the elderly. Saudi J Anaesth, 2023, 17(4): 491-499.
33. Zhang M, Cai P. Application on perioperative ERAS concept in elderly lung cancer patients undergoing surgery. Medicine (Baltimore), 2024, 103(6): e36929.
34. Niyonkuru E, Iqbal MA, Zhang X, et al. Complementary approaches to postoperative pain management: a review of non-pharmacological interventions. Pain Ther, 2025, 14(1): 121-144.
35. Xiang XB, Wu YY, Fang Z, et al. Stellate ganglion block for visceral pain in elderly patients undergoing video-assisted thoracoscopic lung cancer surgery: a randomized, controlled trial. Int J Surg, 2024, 110(11): 6996-7002.
36. Werblińska A, Zielińska D, Szlanga L, et al. The impact of nutritional support on outcomes of lung cancer surgery-narrative review. J Clin Med, 2025, 14(9): 3197.
37. Martínez-Ortega AJ, Piñar-Gutiérrez A, Serrano-Aguayo P, et al. Perioperative nutritional support: a review of current literature. Nutrients, 2022, 14(8): 1601.
38. Koo TH, Leong XB, Zakaria AD. Current trend and outcomes on immunonutrition in medical and surgical fields: an updated perspective. Malays J Med Sci, 2024, 31(6): 65-76.
39. Kasprzyk A, Bilmin K, Chmielewska-Ignatowicz T, et al. The role of nutritional support in malnourished patients with lung cancer. In Vivo, 2021, 35(1): 53-60.
40. Akcam TI, Tekneci AK, Kavurmaci O, et al. The significance of immunonutrition nutritional support in patients undergoing postoperative adjuvant chemotherapy for lung cancer: case-control study. World J Surg Oncol, 2023, 21(1): 183.
41. 中国研究型医院学会老年外科专业委员会. 老年外科患者围手术期营养支持中国专家共识(2024版). 中华消化外科杂志, 2024, 23(5): 629-641.Geriatric Surgery Professional Committee of Chinese Research Hospital Association. Chinese expert consensus on perioperative nutritional support for geriatric surgical patients (2024 edition). Chin J Dig Surg, 2024, 23(5): 629-641.
42. Ding Q, Chen W, Gu Y, et al. Accelerated rehabilitation combined with enteral nutrition in the management of lung cancer surgery patients. Asia Pac J Clin Nutr, 2020, 29(2): 274-279.
43. Lu YN, Liu XX. Postoperative delirium and its influencing factors in elderly patients with lung cancer in the intensive care unit. J Thorac Dis, 2023, 15(2): 701-710.
44. Ting HY, Hu XJ, Peng HR, et al. Perioperative dexmedetomidine reduces delirium in elderly patients after lung cancer surgery. Psychiatr Danub, 2019, 31(1): 95-101.
45. Zhang CL, Yan Y, Zhang Y, et al. Effects of esketamine combined with dexmedetomidine on postoperative delirium and quality of recovery in elderly patients undergoing thoracoscopic radical lung cancer surgery: a randomized controlled trial. CNS Spectr, 2024, 29(5): 441-450.
46. Miyata R, Omasa M, Fujimoto R, et al. Efficacy of ramelteon for delirium after lung cancer surgery. Interact Cardiovasc Thorac Surg, 2017, 24(1): 8-12.
47. Chen CY, Ding H, Wang SS. Effectiveness of Roy adaptation model-based cognitive stimulation therapy in elderly patients with non-small cell lung cancer undergoing curative resection. Tohoku J Exp Med, 2024, 263(1): 27-34.
48. 师思源, 王晓东. 萨提亚团体干预模式在老年肺癌根治术后患者中的应用. 中华现代护理杂志, 2020, 26(6): 769-772.Shi SY, Wang XD. Application of Satir group intervention model in elderly lung cancer patients with radical resection. Chin J Mod Nurs, 2020, 26(6): 769-772.
49. Du J, Wu C, Li A, et al. Effectiveness of enhanced recovery after surgery-based respiratory function exercise in elderly patients with lung cancer and its effect on postoperative functional recovery. Altern Ther Health Med, 2023, 29(6): 56-61.
50. Nguyen NM, Latiers F, Nana FA, et al. The effect of inspiratory muscle training in patients with lung cancer after surgery: a systematic review. Rehabil Oncol, 2023, 41(4): 202-212.
51. Zhang R, Jiang X, Liu W, et al. Effect of graded exercise rehabilitation based on pulmonary function classification on dyspnea, pulmonary function, and exercise capacity in elderly lung cancer patients. Am J Transl Res, 2024, 16(11): 6552-6563.
52. Wang F, Zhang S, Song B, et al. Anxiety, depression, and quality of life in postoperative non-small cell lung cancer patients under the intervention of cognitive-behavioral stress management. Front Psychol, 2023, 14: 1138070.
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Latest ArticlesNew strategy of postoperative comprehensive rehabilitation for elderly patients with lung cancer

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