Journal of thoracic disease · 2026
Effectiveness of electrical stimulation for postoperative rehabilitation of lung cancer: a systematic review and meta-analysis.
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Xie Qing, Chen Ji, Sun Xieping, Yang Tianyu, Tian Jianglian, Chen Guihua, An Zhenxiang
Аннотация
BACKGROUND: Surgery is considered the primary treatment for lung cancer, but postoperative complications and functional limitations lead to longer recovery and hospitalization times. Although electrical stimulation (ES) is considered a promising intervention for overcoming these challenges, existing research findings on ES have limitations due to small sample sizes and incomplete outcome measurements. This systematic review aims to evaluate ES on five important aspects: postoperative pain, complications, exercise capacity, length of stay, and respiratory functions.
METHODS: Databases searched included PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Chinese Science and Technology Journal Database (VIP), Wanfang, and China Biomedical Literature Database (CBM) up to September 2025. Inclusion criteria consisted of randomized controlled trials (RCTs) of ES post-surgery, including both analgesic and functional ES, in adult patients undergoing resection of lung cancer. Comparison interventions included standard care, sham stimulation, or conventional rehabilitation. Pain intensity was the main outcome of interest. Secondary outcomes included complication rates, exercise capacity, hospital stay duration, and pulmonary functions. Methodological quality of the included RCTs was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence for the outcomes of interest was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results are presented as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI).
RESULTS: Analysis of 23 RCTs (n=2,232) indicated that ES reduced postoperative pain (MD: 0.39-0.41 points), although this effect failed to meet the minimum important difference (MID) of 1.0 points. In postoperative morbidity, the ES reduced the incidence of complications and exercise capacity, increasing the 6-minute walk distance (6MWD) by 33.8 m, exceeding the MID of 25 m. Consequently, hospital stay was reduced by 3.2 days. In addition, the improvement in respiratory function, indicated by the increase in forced vital capacity (FVC) (0.25 L), exceeded the MID of 0.15-0.20 L, although the improvement in forced expiratory volume in 1 second (FEV1) (0.13 L) was limited. The quality of evidence for these outcomes, as classified in the GRADE approach, ranged from moderate to low.
CONCLUSIONS: After lung cancer surgery, ES mainly facilitates functional recovery instead of significant early analgesia. ES can increase cardiopulmonary capacity, lower complication risk, and reduce hospital stay. Being a promising passive technique, its clinical importance is obvious; however, in consideration of current heterogeneity in studies, large-scale standardized RCTs are warranted to optimize ES.
METHODS: Databases searched included PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Chinese Science and Technology Journal Database (VIP), Wanfang, and China Biomedical Literature Database (CBM) up to September 2025. Inclusion criteria consisted of randomized controlled trials (RCTs) of ES post-surgery, including both analgesic and functional ES, in adult patients undergoing resection of lung cancer. Comparison interventions included standard care, sham stimulation, or conventional rehabilitation. Pain intensity was the main outcome of interest. Secondary outcomes included complication rates, exercise capacity, hospital stay duration, and pulmonary functions. Methodological quality of the included RCTs was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence for the outcomes of interest was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results are presented as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI).
RESULTS: Analysis of 23 RCTs (n=2,232) indicated that ES reduced postoperative pain (MD: 0.39-0.41 points), although this effect failed to meet the minimum important difference (MID) of 1.0 points. In postoperative morbidity, the ES reduced the incidence of complications and exercise capacity, increasing the 6-minute walk distance (6MWD) by 33.8 m, exceeding the MID of 25 m. Consequently, hospital stay was reduced by 3.2 days. In addition, the improvement in respiratory function, indicated by the increase in forced vital capacity (FVC) (0.25 L), exceeded the MID of 0.15-0.20 L, although the improvement in forced expiratory volume in 1 second (FEV1) (0.13 L) was limited. The quality of evidence for these outcomes, as classified in the GRADE approach, ranged from moderate to low.
CONCLUSIONS: After lung cancer surgery, ES mainly facilitates functional recovery instead of significant early analgesia. ES can increase cardiopulmonary capacity, lower complication risk, and reduce hospital stay. Being a promising passive technique, its clinical importance is obvious; however, in consideration of current heterogeneity in studies, large-scale standardized RCTs are warranted to optimize ES.