Oesophagectomy and chest wall and respiratory function
Research type
Research Study
Full title
Changes in respiratory function and chest wall movement following oesophagectomy
IRAS ID
255725
Contact name
Sheraz Markar
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
2 years, 10 months, 17 days
Research summary
Research Summary:
Open surgery for oesophageal cancer commonly involves large incisions in the chest, associated with a high rate of respiratory complications. Minimally invasive approach through keyhole surgery has been shown to reduce lung infections by 20%. Enhanced recovery programmes are evidence-based protocols aiming at early recovery after surgery with early mobilisation and chest physiotherapy and have been shown to reduce lung complication rates as well. We intend to objectively measure chest wall movement using a 3D motion capture system as well as a wearable measurement system to monitor chest wall movement.
The study population consists of 50 healthy volunteers who have not received upper gastrointestinal surgery and 100 patients treated with surgery more than one year ago (50 open and 50 minimally invasive). Chest wall movement will be measured using a 3D optical motion system and we will establish if inertial measurement units placed strategically on the chest wall are able to quantify chest expansion and lung capacity. Inertial measurement units are sensors developed to define movement. Data will be acquired during different breathing patterns and during use of an incentive spirometry, which is a device that measures lung function and enhances breathing exercises. Lung function tests will be undertaken in all patients and clinical data will be collected for health-related quality of life and other concomitant medical conditions. The target outcome is to determine whether the 3D motion capture and wearable systems are reliable in the measurement of chest wall movement after surgical removal of oesophagus and the validity and patient acceptability of wearable system.
A tailored physiotherapy may be developed following this study in order to improve chest wall movement. This can then be implemented in a clinical trial to provide the evidence base to for patient-tailored physiotherapy following major cancer surgery and to optimise respiratory function.Lay summary of study results:
Lay summary of study results: This study looked at breathing and chest wall movement after surgery for oesophageal cancer. Patients who have had undergone surgical removal of oesophageal cancer often report ongoing symptoms such as reduced physical function, breathlessness, coughing difficulties and reduced quality of life, but the reasons for these longer-term problems are not fully understood. The study used non-invasive tests to assess breathing. These included motion capture markers to measure chest and abdominal displacement during breathing, spirometry to estimate lung volumes, respiratory pressure measurements to estimate breathing muscle strength, and questionnaires on symptoms and quality of life. The study included a feasibility phase and later assessment in healthy volunteers and patients who had undergone oesophageal cancer resection. Preliminary findings showed that the motion capture approach was feasible and reliable for assessing breathing mechanics. Compared with healthy controls, oesophageal cancer survivors had lower spirometry values and greater symptom burden. The study also found that some survivors had greater asymmetry in chest and abdominal movement during breathing, particularly during slow, controlled exhalation. Overall, the findings suggest that long-term problems after oesophagectomy may be related not only to reduced lung volumes but also to altered breathing mechanics. This may be relevant for future rehabilitation approaches and for improving understanding of longer-term recovery after oesophageal cancer surgery.
REC name
London - Surrey Research Ethics Committee
REC reference
19/LO/0362
Date of REC Opinion
4 Mar 2019
REC opinion
Favourable Opinion