Impact of Ivor Lewis oesophageal surgery on breathing movements: A secondary analysis of a randomised controlled study

Background: Limitations in chest-wall function and chronic respiratory impairment are well-known side effects after especially open oesophageal resection. There are no trials evaluating breathing movements after oesophageal resection and whether there is any impact on pre- and postoperative training interventions. The aim was to describe and analyse breathing movements before and after thoracoabdominal oesophageal resection and also to evaluate the impact of a rehabilitation intervention. Method: A subset of patients involved in a randomised, controlled trial assessing the effects of a pre- and postoperative training interventions underwent evaluation of breathing movements using a Respiratory Movement Measuring Instrument, both prior to and three months postoperatively. We included in total 38 patients, of which 20 underwent pre- and postoperative interventions comprising physical and respiratory training, and 18 served as controls. The training included respiratory muscle training, four strength training exercises, and enhanced general physical activity. Results: Postoperative breathing movement decreased in the control group (-2.0 mm on the surgical right side and -1.5 mm on the left side), while the intervention group showed a smaller reduction and even a median increase (+2.7mm on the right, and +4.2 mm on the left). Both groups demonstrated a wide range of interindividual variation. Conclusion: An open access (thoracotomy) Ivor-Lewis oesophageal resection results in decreased breathing movements. A specific pre- and postoperative training intervention resulted in less deterioration. Trial registration: ClinicalTrials.gov (NCT03452319), registered 23 February 2023; FoU i VGR: 238651. Trial title: Effects of Increased Physical Activity Before Thoracoabdominal Esophageal Surgery.