Abstract: Objective To evaluate the effect of lung pre-rehabilitation program combined with lung protective ventilation strategy on postoperative pulmonary complications in patients with esophageal cancer. Methods A total of 85 patients underwent endoscopic surgery （McKeown） in Weifang People's Hospital from June 2022 to December 2023 were enrolled in the study, and according to the method of random number table, divided into two groups. The control group （n=42） received routine preoperative health education, postoperative respiratory training, and complication prevention, with no specific recommendations for psychology, diet, and exercise. The pre-rehabilitation group （n=43） received a multimodal intervention program two weeks before surgery on the basis of the control group, including psychological counseling, nutritional guidance, respiratory training, and aerobic exercise. The primary endpoint was the incidence of pulmonary complications （pneumonia, atelectasis） within 7 d after surgery, and the secondary endpoints included lung function, thoracic drainage tube indwelling time, and length of hospital stay. Results There were no significant differences in age, gender, American Society of Anesthesiologists （ASA） classification, intraoperative blood loss, and operation time between the two groups. Compared with the control group, the incidence of postoperative pneumonia was lower in the pre-rehabilitation group （t=4.435, P=0.035）, while there was no significant difference in the incidence of atelectasis. The thoracic drainage tube indwelling time （P=0.006） and length of hospital stay （P=0.009） were shorter in the pre-rehabilitation group than in the control group. The forced vital capacity （FVC） was higher in the pre-rehabilitation group than in the control group 7 d after surgery （P=0.023）, but there was no significant difference in forced expiratory volume in one second （FEV₁） （P>0.05）. The platform pressure （Pplat） after artificial pneumothorax during surgery was significantly lower in the pre-rehabilitation group than in the control group （P<0.01）. Conclusion A two-week pre-rehabilitation combined with intraoperative lung protective ventilation strategy has significant benefits for patients with McKeown surgery, reducing postoperative pulmonary complications, thoracic drainage tube indwelling time, and hospitalization time.

Key words: Pre-rehabilitation, Esophageal cancer, Pulmonary function, Postoperative pulmonary complications