Respiratory Rehabilitation Does not Prevent Post-Pperative Pulmonary Complications, Morbidity and Mortality After Esophagectomy.- A Systematic Review and Meta-Analysis.

Aim: The analysis aimed to study the effect of preoperative pulmonary rehabilitation on post-operative pulmonary complications, overall morbidity, and mortality after esophagectomy.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (2020) and MOOSE guidelines. The meta-analysis was done using Review Manager 5.4. We compared postoperative pneumonia, postoperative pulmonary complications, morbidity, and mortality between the preoperative respiratory group vs. no prehabilitation group. Heterogeneity was evaluated using the I2 test. The random-effect model was used with I2 was more than 25% otherwise fixed-effect model was used. I2 less than 25%, 25-50%, and more than 50% were taken as low, moderate, or high heterogeneity.Results: Seven studies consisting of. 606 patients were included in the analysis. 322 patients in the respiratory prehabilitation group and 284 in the control group. There was no statistically significant difference in postoperative pneumonia (p=0.11), post-operative pulmonary complications (p= 0.09), All cause morbidity and mortality. (p=0.98, and 0.30 respectively). However, heterogeneity was moderate to high in most analyses.Conclusion: There is no conclusive evidence as of now regarding the benefits of preoperative pulmonary rehabilitation in esophagectomy. However, further studies are needed to confirm it.