Göğüs Cerrahisi Ameliyatlarından Sonra Ne Zaman Spor Yapılabilir?
Özet
Göğüs cerrahisi, ilgilendiği hastalık yelpazesi bakımından genç bireylerden ileri yaş grubuna kadar geniş bir hasta popülasyonunu kapsar. Göğüs cerrahisinin en temel uygulama alanlarından biri olan akciğer kanseri ameliyatları genellikle 50 yaşın üzerindeki hastaları ilgilendirirken; pektus ekskavatumda uygulanan Nuss prosedürü, primer spontan pnömotoraks ve torasik outlet sendromu gibi hastalıklar daha çok genç ve sporcu hasta grubunda daha fazla görülür. Cerrahi girişimin tipi, insizyon tekniği, rezeksiyonun yeri ve genişliği gibi birçok faktör; ameliyat sonrası dönemde fiziksel aktiviteyi doğrudan etkileyen belirleyici unsurlardır. Örneğin son yıllarda minimal invaziv cerrahi tekniklerin yaygınlaşmasıyla, postoperatif iyileşme süreci belirgin şekilde hızlanmış; ağrı düzeyinde azalma, kas bütünlüğünün korunması ve erken mobilizasyon sayesinde spora dönüş daha kısa sürede mümkün hâle gelmiştir. Akciğer kanserinde ise yapılan rezeksiyonun tipi (sublober rezeksiyon, lobektomi ya da pnömonektomi) ve etkilenen yapılar (akciğer parankimi ve/veya toraks duvarı) hastanın postoperatif egzersiz kapasitesini doğrudan etkileyen en önemli parametrelerdendir. Bu nedenle spora dönüş süreci, bireyselleştirilmiş bir yaklaşımla planlanmalıdır.
Referanslar
Chang B, Tucker WD, Burns B. Thoracotomy. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: William Tucker declares no relevant financial relationships with ineligible companies. Disclosure: Bracken Burns declares no relevant financial relationships with ineligible companies.2025.
Kucukarslan N, Kirilmaz A, Arslan Y, et al. Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy. Pediatric Surgery International. 2006;22(10):779-783.
Uzzaman MM, Robb JD, Mhandu PC, et al. A meta-analysis comparing muscle-sparing and posterolateral thoracotomy. The Annals of Thoracic Surgery. 2014;97(3):1093-1102.
Landreneau RJ, Pigula F, Luketich JD, et al. Acute and chronic morbidity differences between muscle-sparing and standard lateral thoracotomies. The Journal of Thoracic and Cardiovascular Surgery. 1996;112(5):1346-1350; discussion 1350-1341.
Akcali Y, Demir H, Tezcan B. The effect of standard posterolateral versus muscle-sparing thoracotomy on multiple parameters. The Annals of Thoracic Surgery. 2003;76(4):1050-1054.
Ziyade S, Baskent A, Tanju S, et al. Isokinetic muscle strength after thoracotomy: standard vs. muscle-sparing posterolateral thoracotomy. The Journal of Thoracic and Cardiovascular Surgery. 2010;58(5):295-298.
Kutlu CA, Akin H, Olcmen A, et al. Shoulder-girdle strength after standard and lateral muscle-sparing thoracotomy. The Journal of Thoracic and Cardiovascular Surgery. 2001;49(2):112-114.
Mijatovic D, Bhalla T, Farid I. Post-thoracotomy analgesia. Saudi Journal of Anaesthesia. 2021;15(3):341-347.
Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Supplement. 1986;3:S1-226.
Bayman EO, Brennan TJ. Incidence and severity of chronic pain at 3 and 6 months after thoracotomy: meta-analysis. The Journal of Pain. 2014;15(9):887-897.
Mehrotra M, D'Cruz JR, Bishop MA, et al. Video-Assisted Thoracoscopy. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Jason D'Cruz declares no relevant financial relationships with ineligible companies. Disclosure: Michael Bishop declares no relevant financial relationships with ineligible companies. Disclosure: Mary Arthur declares no relevant financial relationships with ineligible companies.2025.
Sirakaya F, Calik Kutukcu E, Onur MR, et al. The Effects of Various Approaches to Lobectomies on Respiratory Muscle Strength, Diaphragm Thickness, and Exercise Capacity in Lung Cancer. Annals of Surgical Oncology. 2024;31(9):5738-5747.
Bendixen M, Jorgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. The Lancet Oncology. 2016;17(6):836-844.
Villamizar NR, Darrabie MD, Burfeind WR, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. The Journal of Thoracic and Cardiovascular Surgery. 2009;138(2):419-425.
Taioli E, Lee DS, Lesser M, et al. Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: a meta-analysis. European Journal of Cardio-Thoracic Surgery. 2013;44(4):591-597.
Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. European Journal of Cardio-Thoracic Surgery. 2013;43(4):813-817.
Nagahiro I, Andou A, Aoe M, et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. The Annals of Thoracic Surgery. 2001;72(2):362-365.
Singer ES, Kneuertz PJ, Nishimura J, et al. Effect of operative approach on quality of life following anatomic lung cancer resection. Journal of Thoracic Disease. 2020;12(11):6913-6919.
Zhang J, Yip R, Taioli E, et al. Quality of life outcomes after robotic-assisted and video-assisted thoracoscopic surgery for early-stage non-small cell lung cancer. JTCVS Open. 2025;24:383-393.
Asemota N, Maraschi A, Lampridis S, et al. Comparison of Quality of Life after Robotic, Video-Assisted, and Open Surgery for Lung Cancer. Journal of Clinical Medicine. 2023;12(19).
Zheng L, Song P, Jiang Y, et al. Outcomes and quality of life after Robot-assisted lobectomy/segmentectomy for lung cancer compared to video-assisted thoracoscopic surgery: both three-port procedures performed by a single surgeon. Journal of Thoracic Disease. 2022;14(3):689-698.
Gaudino M, Audisio K, Rahouma M, et al. Association between sternal wound complications and 10-year mortality following coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery. 2023;166(2):532-539 e534.
van Venrooij LM, Verberne HJ, de Vos R, et al. Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery. Nutrition. 2012;28(1):40-45.
Wiens K, Hayden KA, Park L, et al. Post-sternotomy movement strategies in adults: a scoping review. European Journal of Cardiovascular Nursing. 2024;23(5):435-440.
Cahalin LP, Lapier TK, Shaw DK. Sternal Precautions: Is It Time for Change? Precautions versus Restrictions - A Review of Literature and Recommendations for Revision. Cardiopulmonary Physical Therapy Journal. 2011;22(1):5-15.
Adams J, Lotshaw A, Exum E, et al. An alternative approach to prescribing sternal precautions after median sternotomy, "Keep Your Move in the Tube". Baylor University Medical Center Proceedings. 2016;29(1):97-100.
Winningham ML, MacVicar MG, Burke CA. Exercise for Cancer Patients: Guidelines and Precautions. The Physician and Sportsmedicine. 1986;14(10):125-134.
Cormie P, Zopf EM, Zhang X, et al. The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects. Epidemiologic Reviews. 2017;39(1):71-92.
Avancini A, Sartori G, Gkountakos A, et al. Physical Activity and Exercise in Lung Cancer Care: Will Promises Be Fulfilled? Oncologist. 2020;25(3):e555-e569.
Ostroff JS, Krebs P, Coups EJ, et al. Health-related quality of life among early-stage, non-small cell, lung cancer survivors. Lung Cancer. 2011;71(1):103-108.
Rauma V, Sintonen H, Rasanen JV, et al. Long-term lung cancer survivors have permanently decreased quality of life after surgery. Clinical Lung Cancer. 2015;16(1):40-45.
Lin YY, Liu MF, Tzeng JI, et al. Effects of Walking on Quality of Life Among Lung Cancer Patients: A Longitudinal Study. Cancer Nursing. 2015;38(4):253-259.
Sommer MS, Trier K, Vibe-Petersen J, et al. Changes in Health-Related Quality of Life During Rehabilitation in Patients With Operable Lung Cancer: A Feasibility Study (PROLUCA). Integrative Cancer Therapies. 2018;17(2):388-400.
Edvardsen E, Skjonsberg OH, Holme I, et al. High-intensity training following lung cancer surgery: a randomised controlled trial. Thorax. 2015;70(3):244-250.
Henke CC, Cabri J, Fricke L, et al. Strength and endurance training in the treatment of lung cancer patients in stages IIIA/IIIB/IV. Supportive Care in Cancer. 2014;22(1):95-101.
Tane S, Nishio W, Nishioka Y, et al. Evaluation of the Residual Lung Function After Thoracoscopic Segmentectomy Compared With Lobectomy. The Annals of Thoracic Surgery. 2019;108(5):1543-1550.
Gu Z, Wang H, Mao T, et al. Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery. Journal of Thoracic Disease. 2018;10(4):2331-2337.
Wang X, Guo H, Hu Q, et al. Pulmonary function after segmentectomy versus lobectomy in patients with early-stage non-small-cell lung cancer: a meta-analysis. Journal of International Medical Research. 2021;49(9):3000605211044204.
Altorki N, Wang X, Kozono D, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. The New England Journal of Medicine. 2023;388(6):489-498.
Jiang S, Wang B, Zhang M, et al. Quality of life after lung cancer surgery: sublobar resection versus lobectomy. BMC Surg. 2023;23(1):353.
Deslauriers J, Ugalde P, Miro S, et al. Adjustments in cardiorespiratory function after pneumonectomy: results of the pneumonectomy project. The Journal of Thoracic and Cardiovascular Surgery. 2011;141(1):7-15.
Menna C, Ciccone AM, Ibrahim M, et al. Pneumonectomy: quality of life and long-term results. Minerva Chirurgica. 2012;67(3):219-226.
Leo F, Scanagatta P, Vannucci F, et al. Impaired quality of life after pneumonectomy: who is at risk? The Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):49-52.
Vainshelboim B, Fox BD, Saute M, et al. Limitations in exercise and functional capacity in long-term postpneumonectomy patients. Journal of Cardiopulmonary Rehabilitation and Prevention. 2015;35(1):56-64.
Scarnecchia E, Liparulo V, Capozzi R, et al. Chest wall resection and reconstruction for tumors: analysis of oncological and functional outcome. Journal of Thoracic Disease. 2018;10(Suppl 16):S1855-S1863.
Daigeler A, Druecke D, Hakimi M, et al. Reconstruction of the thoracic wall-long-term follow-up including pulmonary function tests. Langenbeck's Archives of Surgery. 2009;394(4):705-715.
Salo JTK, Repo JP, Roine RP, et al. Health-related quality of life after oncological resection and reconstruction of the chest wall. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2019;72(11):1776-1784.
Heuker D, Lengele B, Delecluse V, et al. Subjective and objective assessment of quality of life after chest wall resection. European Journal of Cardio-Thoracic Surgery. 2011;39(1):102-108.
Forster C, Jacques V, Abdelnour-Berchtold E, et al. Enhanced recovery after chest wall resection and reconstruction: a clinical practice review. Journal of Thoracic Disease. 2024;16(4):2604-2612.
Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Annals of Cardiothoracic Surgery. 2016;5(5):422-433.
Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience. Journal of Thoracic Disease. 2015;7(Suppl 2):S172-176.
Acosta J, Bradley A, Raja V, et al. Exercise improvement after pectus excavatum repair is not related to chest wall function. European Journal of Cardio-Thoracic Surgery. 2014;45(3):544-548.
Uramoto H, Shimokawa H, Tanaka F. What factors predict recurrence of a spontaneous pneumothorax? Journal of Cardiothoracic Surgery. 2012;7:112.
Dearden AS, Sammon PM, Matthew EF. In patients undergoing video-assisted thoracic surgery for pleurodesis in primary spontaneous pneumothorax, how long should chest drains remain in place prior to safe removal and subsequent discharge from hospital? Interactive CardioVascular and Thoracic Surgery. 2013;16(5):686-691.
Walker SP, Bibby AC, Halford P, et al. Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis. European Respiratory Journal. 2018;52(3).
Vuong NL, Elshafay A, Thao LP, et al. Efficacy of treatments in primary spontaneous pneumothorax: A systematic review and network meta-analysis of randomized clinical trials. Respiratory Medicine. 2018;137:152-166.
Aghajanzadeh M, Ashoobi MT, Ziabari SMZ, et al. Evaluation of the Relationship Between Primary Spontaneous Pneumothorax and Exercise and Return to Previous Activities in Patients Referring to Hospitals of Rasht during 2015-2017. Ethiopian Journal of Health Sciences. 2021;31(3):619-624.
Davis PF. Primary spontaneous pneumothorax in a track athlete. Clinical Journal of Sport Medicine. 2002;12(5):318-319.
Kaplan J, Kanwal A. Thoracic Outlet Syndrome. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Arjun Kanwal declares no relevant financial relationships with ineligible companies.2025.
Garraud T, Pomares G, Daley P, et al. Thoracic Outlet Syndrome in Sport: A Systematic Review. Frontiers in Physiology. 2022;13:838014.
Umana E, Elsherif M, Binchy J. A Case of Paget-Schroetter Syndrome in a Young Male After Lifting Weights. Irish Medical Journal. 2019;112(2):873.
DeLisa LC, Hensley CP, Jackson S. Diagnosis of Paget-Schroetter Syndrome/Primary Effort Thrombosis in a Recreational Weight Lifter. Physical Therapy. 2017;97(1):13-19.
6Chandra V, Little C, Lee JT. Thoracic outlet syndrome in high-performance athletes. Journal of Vascular Surgery. 2014;60(4):1012-1017; discussion 1017-1018.
Thompson RW, Dawkins C, Vemuri C, et al. Performance Metrics in Professional Baseball Pitchers before and after Surgical Treatment for Neurogenic Thoracic Outlet Syndrome. Annals of Vascular Surgery. 2017;39:216-227.
M JG, Gutman BS, C DJ, et al. Performance in major league baseball pitchers after surgical treatment of thoracic outlet syndrome. The Physician and Sportsmedicine. 2022;50(2):141-146.
