A Perioperative Multidisciplinary Management Protocol for Patients Undergoing Lung Cancer Resection: Implementation and Outcomes Analysis

Summary

This protocol details a multidisciplinary perioperative care pathway for lung cancer surgery, integrating prehabilitation, lung-protective strategies, and structured rehabilitation to reduce complications, enhance the quality of acute recovery, and significantly improve 90-day survival.

Abstract

Effective perioperative care is critical for optimizing outcomes after lung cancer surgery. This protocol details the implementation of a structured, multidisciplinary perioperative management bundle designed to enhance recovery and reduce complications. The protocol encompasses three phases: preoperative (including risk assessment, pulmonary rehabilitation, psychological support, and nutritional optimization), intraoperative (featuring lung-protective ventilation strategies), and postoperative (emphasizing early mobilization, multimodal analgesia, and continuous multidisciplinary team coordination). To assess the feasibility and potential impact of this protocol, it was applied to a cohort of patients undergoing lung cancer resection. Clinical outcomes, including postoperative complications, length of hospital stay, perioperative recovery quality, and short-term survival, were analyzed and compared with those receiving conventional perioperative care. The results indicated that high adherence to this comprehensive protocol was associated with a significant reduction in overall postoperative complications (10.0% vs. 29.1%, P < 0.001) and postoperative pneumonia (3.3% vs. 11.0%, P = 0.022). Although the hospital length of stay was statistically comparable between the groups (7.16 ± 3.32 days vs. 7.02 ± 3.66 days, P = 0.731), the comprehensive protocol group demonstrated vastly superior recovery efficiency, characterized by a substantial reduction in maximal acute pain scores (3.47 ± 1.01 vs. 5.17 ± 1.45, P < 0.001) and a major increase in patient satisfaction (91.82 ± 3.67 vs. 83.06 ± 6.13, P < 0.001) without compromising 30-day readmission safety. Most importantly, the protocol served as an independent protective factor that markedly improved 90-day survival (10.0% mortality vs. 29.9% in the conventional care group, P < 0.001). This article provides a step-by-step guide for implementing this multidisciplinary management protocol, supported by rigorously audited clinical outcome data, serving as a practical operational framework for other institutions aiming to standardize and improve perioperative care pathways and short-term survival tracking in thoracic surgery.

Introduction

Lung cancer remains one of the most prevalent and deadly malignancies worldwide, with surgical resection constituting a cornerstone of curative treatment for early-stage disease^1,2,3. However, the perioperative period presents significant risks, including functional decline and early mortality, which can undermine surgical success^4,5. Postoperative complications, particularly pulmonary infections, and compromised baseline status are key barriers to this ideal clinical pathway^6,

Protocol

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Affiliated Kunshan Hospital of Jiangsu University and the First People’s Hospital of Taicang (Approval No. 2022-06-031). Written informed consent was obtained from all participants before their inclusion in the study. The overall pathway of the protocol is summarized in Figure 1.

NOTE: This protocol describes the standardized perioperative management bundle. The following steps outline its implementation for a patient scheduled for lung cancer resection.

1. ....

Results

To evaluate the application effects of this comprehensive management protocol, this study collected and analyzed clinical data from patients undergoing lung cancer resection. The cohort consisted of patients managed according to this protocol, along with a comparable control group receiving conventional perioperative care.

Protocol implementation and baseline characteristics

The baseline clinical, demographic, and surgical characteristics of the stu.......

Discussion

This methodology article presents a structured, multidisciplinary perioperative management protocol for lung cancer resection, detailing its components and implementation workflow. Representative results from applying this protocol in a clinical cohort demonstrate its association with improved postoperative outcomes, including reduced complications, reduced pain, higher patient satisfaction, and improved short-term survival. This discussion interprets these findings within the context of existing evidence, elucidates the.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Argyle Small-Bore Thoracic Catheter	Cardinal Health	8888571200	Straight single-use polyvinyl chloride chest tube (20-24 Fr) for optimized pleural drainage following VATS.
Celecoxib Capsules	Pfizer	https://www.pfizer.com	Baseline scheduled selective COX-2 inhibitor oral analgesic administered postoperatively (200 mg q12h).
da Vinci Xi Surgical System	Intuitive Surgical	IS4000	Advanced robotic surgical system utilized for minimally invasive anatomical lung resections.
Endo GIA Ultra Universal Stapler and Reloads	Medtronic	EGIAUSTND	Endoscopic linear cutting staplers utilized for secure division of pulmonary vessels, bronchi, and fissures.
GraphPad Prism	GraphPad Software	https://www.graphpad.com/	Statistical graphing software used for generating postoperative complication distribution bar charts.
High-End Anesthesia Workstation Primus	Draeger Medical	System Configuration	Advanced anesthesia platform for administering intraoperative lung-protective ventilation parameters during one-lung ventilation.
High-Protein Oral Nutritional Supplement	Nutricia	https://www.nutricia.com	High-protein oral formula prescribed for nutritionally at-risk patients (PG-SGA score $\ge$ 4) prior to resection.
Hospital Anxiety and Depression Scale	Western Psychological Services	https://www.wpspublish.com	Clinical psychometric questionnaire administered by the nurse specialist for preoperative psychological risk screening.
Numeric Rating Scale Assessment Tool	Standard Clinical Form	Clinical Standard Scale	10-point scale utilized every 4 hours for dynamic postoperative pain monitoring and targeted rescue analgesia titration.
Paracetamol Injection	Local Pharmaceutical Provider	Standard Pharmaceutical	Core component of the non-opioid multimodal analgesia regimen (1g IV/PO q6h).
PASS Power Analysis Software	NCSS, LLC	https://www.ncss.com/software/pass/	Power analysis and sample size software utilized during the initial study design phase.
Patient-Controlled Analgesia Pump	Baxter	7130P	Infusion pump system for delivering postoperative continuous regional or systemic analgesia.
Preoperative Carbohydrate Loading Drink	Local Clinical Provider	Clinical Nutrition Protocol	Clear 12.5% carbohydrate drink administered as a 400 mL oral dose 2 hours prior to anesthesia induction.
R Software	R Foundation for Statistical Computing	https://www.r-project.org/	Statistical programming environment used for data baseline balancing, multivariable regression, and survival analysis.
SPSS Statistics	IBM	https://www.ibm.com/spss	Statistical software utilized for baseline population clinical characteristics description and univariate filtering.
Thopaz+ Digital Chest Drainage and Monitoring System	Medela AG	77	Electronic digital chest drainage system providing continuous objective air leak tracking (mL/min) to accelerate tube removal.
Thoracic Epidural Analgesia Catheter Kit	Arrow International	AR-05500	Epidural catheter kit used for continuous intraoperative and postoperative regional analgesia delivery.
VATS Endoscopic Camera and Tower System	Karl Storz	IMAGE1 S	High-definition thoracoscopic visualization stack utilized for standard video-assisted thoracic surgery approaches.
Volumetric Incentive Spirometer Voldyne 5000	Teleflex	175502	Volumetric breathing training device utilized for supervised preoperative and postoperative pulmonary rehabilitation.