Clinical application and advantages of the "three-dimensional integrated" respiratory training model in the perioperative care of pulmonary nodule ablation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHEN Cheng ¹ , YANG Maodan ² , GUAN Min ³ , CHEN Lei ¹ , DENG Qian ² , LIN Yating ⁴ , SHEN Xu ² , ZHANG Suting ² , GUO Shuhan ³ , CHENG Liang ² , SONG Shangqi ¹ , LIAO Hu ¹ ,  NIU Lingli ¹ ,  ZHU Yunke ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, Shangjin Hospital of West China Hospital, Sichuan University/Chengdu Shangjin Nanfu Hospital, Chengdu, 611743, P. R. China;
3. Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. Department of Rehabilitation, Shangjin Hospital of West China Hospital, Sichuan University/Chengdu Shangjin Nanfu Hospital, Chengdu, 611743, P. R. China;

Corresponding?author：

NIU Lingli, Email: 117320925@qq.com; ZHU Yunke, Email: yunke_zhu@qq.com

Keywords：

Lung cancer; minimally invasive surgery; rehabilitation training; radiofrequency ablation; cryoablation; safety; efficacy; perioperative management

DOI：

10.7507/1007-4848.202601081

Video：

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Objective To summarize and analyze the standardized operational procedure and preliminary clinical outcomes of a "three-dimensional integrated" respiratory training model, and to propose a safe adjunctive intervention for the perioperative management of lung nodule ablation. Methods Clinical data from patients who underwent lung nodule ablation at West China Hospital, Sichuan University from August to December 2025 were consecutively enrolled and analyzed. Results A total of 18 patients were included, comprising 10 males and 8 females, with a mean age of (62.8±11.2) years. Following the implementation of the preoperative "three-dimensional integrated" respiratory training model, the mean breath-holding time significantly increased from (22.9±7.5) s at admission to (32.6±6.9) s preoperatively (P<0.01). The volume measured on the respiratory trainer improved from a mean of(1 247.2±518.9) mL at admission to (1 550.0±546.1) mL preoperatively (P<0.01). Ablation modalities included radiofrequency ablation in 17 (94.4%) patients and cryoablation in 1 (5.6%) patient. During the ablation procedure, the mean number of needle adjustments was (1.4±0.8) times, and the mean localization time was (15.6±4.4) min. All patients successfully completed the ablation therapy, achieving a technical success rate of 100.0% with no intraoperative complications. Conclusion The "three-dimensional integrated" respiratory training model effectively enhances patients' surgical tolerance, cooperation, and procedural precision. It offers a new, safe, and effective perioperative management strategy, especially for high-risk patients (e.g., the elderly or those with poor lung function) who may be unable to tolerate conventional surgery. This model demonstrates promising potential for widespread clinical application.

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2.	Pawlik P, Grigoriadis K, Bunkum A, et al. Clone copy number diversity is linked to survival in lung cancer. Nature, 2025, 646(8083): 190-197.
3.	Díaz-Gay M, Zhang T, Hoang PH, et al. The mutagenic forces shaping the genomes of lung cancer in never smokers. Nature, 2025, 644(8075): 133-144.
4.	Christie I, Luketich JD, Schuchert MJ, et al. Image-guided radiofrequency ablation for treatment of stage Ⅰ non-small cell lung cancer in 111 high-risk patients: analysis of prognostic variables. J Thorac Cardiovasc Surg, 2026, 171(2): 500-509.
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6.	Guo RQ, Li YM, Bie ZX, et al. Microwave ablation of non-small cell lung cancer enhances local T-cell abundance and alters monocyte interactions. BMC Cancer, 2025, 25(1): 605.
7.	Hu Y, Li D, Ding M, et al. Microwave ablation for residual ground-glass nodule-like lung cancer after video-assisted thoracoscopic surgery: a retrospective, large-sample, multicenter study. Radiol Med, 2026, 131(1): 58-68.
8.	Lin X, Zhou J, Wang B, et al. Safety and feasibility of computed tomography-guided radiofrequency ablation for treating high-risk pulmonary nodules in postoperative lung cancer patients. J Int Med Res, 2025, 53(9): 3000605251382006.
9.	Moscho DC, Graur A, Tang JSN, et al. Safety and effectiveness of non-small cell lung cancer cryoablation and microwave ablation involving previously irradiated lung. J Vasc Interv Radiol, 2026, 37(1): 107900.
10.	Onyeji PC, Kaur A, Consoli L, et al. Microwave ablation combined with chemotherapy versus chemotherapy alone in patients with advanced non-small cell lung cancer-systematic review and meta-analysis. Thorac Cancer, 2026, 17(1): e70221.
11.	Peng J, Luo J, Yang L, et al. Efficacy and safety of CT-guided microwave ablation for stage Ⅰ non-small cell lung cancer in elderly patients. Cancer Imaging, 2025, 25(1): 100.
12.	Rehman S, Naidu S, Mehdi RS, et al. Lung ablation outcomes for inoperable stage ⅠA non-small cell lung cancer. J Vasc Interv Radiol, 2026, 37(3): 107974.
13.	Wang Y, Guo R, Bie Z, et al. Safety and efficacy of co-ablation vs. microwave ablation in the treatment of subpleural stage Ⅰ non-small cell lung cancer: a comparative study. J Thorac Dis, 2025, 17(8): 5534-5546.
14.	Xu B, Chen Z, Liu D, et al. Comparison of outcomes between ablation and lobectomy in stage ⅠA non-small cell lung cancer: a retrospective multicenter study. Respirology, 2025, 30(12): 1192-1201.
15.	Xu B, Huang D, Liu D, et al. Ablation versus sublobar resection for stage ⅠA non-small cell lung cancer: a multicenter retrospective cohort study using a deep learning model in the ablation group. Int J Surg, 2025.
16.	Xu R, Zhang G, Che Y, et al. Ablation combined with video-assisted thoracic surgery hybrid technique for multiple primary lung cancer. iScience, 2025, 28(6): 112703.
17.	Ji D, Fu Y, Wu L, et al. Effect of pelvic floor muscle combined with pulmonary rehabilitation training on lung function in elderly patients after surgery for intertrochanteric fractures of the femur: a randomized controlled trial. Eur J Med Res, 2025, 30(1): 381.
18.	Zhao C, Bi Y. Effect of lung rehabilitation exercise on the postoperative respiratory function of patients with lung cancer. Asian J Surg, 2022, 45(10): 2012.
19.	Cheng X. Effects of lung rehabilitation therapy in improving respiratory motor ability and alleviating dyspnea in patients with lung cancer after lobectomy: a clinical study. Altern Ther Health Med, 2022, 28(3): 18-23.
20.	Hu Y, Cheng Q, Guo Q. The role of preoperative lung rehabilitation training combined with nutritional intervention on surgical tolerance and accelerated recovery indicators in patients with moderate to severe COPD complicated with lung cancer. Front Surg, 2025, 12: 1667085.
21.	Ye X. Surgery plus ablation (SPA): an emerging treatment modality for multiple ground glass nodule-like lung cancer. J Cancer Res Ther, 2025, 21(6): 1095-1097.
22.	Zhao H, Wu J, Hu W, et al. Minimally invasive lung resection combined with CT guided percutaneous microwave ablation for the treatment of lung cancer: diagnosis of postoperative nerve damage. Arch Physiol Biochem, 2025. Epub ahead of print.
23.	Bourdas DI, Tsakiris TS, Pavlakis KI, et al. Repeated apneas and hypercapnic ventilatory response before and after apnea training. Aerosp Med Hum Perform, 2015, 86(1): 27-33.
24.	張海廷, 段洪連, 王維. 屏氣訓練在腦缺氧預適應中的可行性及作用機制探討. 神經損傷與功能重建, 2025, 20(10): 587-590.Zhang HT, Duan HL, Wang W. Exploring the feasibility and mechanisms of breath-holding training in cerebral hypoxia preconditioning. Neural Inj Funct Reconstruc, 2025, 20(10): 587-590.
25.	Luo X, Chen G, Zhang S, et al. Visualized breath-hold training for reducing respiratory motion artifacts in liver dynamic contrast-enhanced magnetic resonance imaging. Quant Imaging Med Surg, 2025, 15(8): 7090-7100.
26.	Allinger J, Bouyeure A, Noulhiane M, et al. Monitoring the breath-hold training load during an ecological session: a pilot study. Int J Sports Med, 2024, 45(11): 837-843.
27.	Yang K, Wang WB, Yu ZH, et al. Eight weeks of dry dynamic breath-hold training results in larger spleen volume but does not increase haemoglobin concentration. Front Physiol, 2022, 13: 925539.
28.	Mayr NA, Borm KJ, Kalet AM, et al. Reducing cardiac radiation dose from breast cancer radiation therapy with breath hold training and cognitive behavioral therapy. Top Magn Reson Imaging, 2020, 29(3): 135-148.
29.	Joulia F, Steinberg JG, Faucher M, et al. Breath-hold training of humans reduces oxidative stress and blood acidosis after static and dynamic apnea. Respir Physiol Neurobiol, 2003, 137(1): 19-27.
30.	Guézennec J, Correa D, Billaut F. Influence of the combination of end-expiratory breath-hold training and inspiratory muscle training on performance in artistic swimmers. Appl Physiol Nutr Metab, 2026, 51: 1-12.

1. Chan JE, Pan CH, Rub J, et al. Critical role for a high-plasticity cell state in lung cancer. Nature, 2026, 651(8104): 231-241.
2. Pawlik P, Grigoriadis K, Bunkum A, et al. Clone copy number diversity is linked to survival in lung cancer. Nature, 2025, 646(8083): 190-197.
3. Díaz-Gay M, Zhang T, Hoang PH, et al. The mutagenic forces shaping the genomes of lung cancer in never smokers. Nature, 2025, 644(8075): 133-144.
4. Christie I, Luketich JD, Schuchert MJ, et al. Image-guided radiofrequency ablation for treatment of stage Ⅰ non-small cell lung cancer in 111 high-risk patients: analysis of prognostic variables. J Thorac Cardiovasc Surg, 2026, 171(2): 500-509.
5. Dong Z, Shen C, Zhang J, et al. Integrating surgery and ablative therapies for the management of multiple primary lung cancer: a systematic review. Cancers (Basel), 2025, 17(22): 3699.
6. Guo RQ, Li YM, Bie ZX, et al. Microwave ablation of non-small cell lung cancer enhances local T-cell abundance and alters monocyte interactions. BMC Cancer, 2025, 25(1): 605.
7. Hu Y, Li D, Ding M, et al. Microwave ablation for residual ground-glass nodule-like lung cancer after video-assisted thoracoscopic surgery: a retrospective, large-sample, multicenter study. Radiol Med, 2026, 131(1): 58-68.
8. Lin X, Zhou J, Wang B, et al. Safety and feasibility of computed tomography-guided radiofrequency ablation for treating high-risk pulmonary nodules in postoperative lung cancer patients. J Int Med Res, 2025, 53(9): 3000605251382006.
9. Moscho DC, Graur A, Tang JSN, et al. Safety and effectiveness of non-small cell lung cancer cryoablation and microwave ablation involving previously irradiated lung. J Vasc Interv Radiol, 2026, 37(1): 107900.
10. Onyeji PC, Kaur A, Consoli L, et al. Microwave ablation combined with chemotherapy versus chemotherapy alone in patients with advanced non-small cell lung cancer-systematic review and meta-analysis. Thorac Cancer, 2026, 17(1): e70221.
11. Peng J, Luo J, Yang L, et al. Efficacy and safety of CT-guided microwave ablation for stage Ⅰ non-small cell lung cancer in elderly patients. Cancer Imaging, 2025, 25(1): 100.
12. Rehman S, Naidu S, Mehdi RS, et al. Lung ablation outcomes for inoperable stage ⅠA non-small cell lung cancer. J Vasc Interv Radiol, 2026, 37(3): 107974.
13. Wang Y, Guo R, Bie Z, et al. Safety and efficacy of co-ablation vs. microwave ablation in the treatment of subpleural stage Ⅰ non-small cell lung cancer: a comparative study. J Thorac Dis, 2025, 17(8): 5534-5546.
14. Xu B, Chen Z, Liu D, et al. Comparison of outcomes between ablation and lobectomy in stage ⅠA non-small cell lung cancer: a retrospective multicenter study. Respirology, 2025, 30(12): 1192-1201.
15. Xu B, Huang D, Liu D, et al. Ablation versus sublobar resection for stage ⅠA non-small cell lung cancer: a multicenter retrospective cohort study using a deep learning model in the ablation group. Int J Surg, 2025.
16. Xu R, Zhang G, Che Y, et al. Ablation combined with video-assisted thoracic surgery hybrid technique for multiple primary lung cancer. iScience, 2025, 28(6): 112703.
17. Ji D, Fu Y, Wu L, et al. Effect of pelvic floor muscle combined with pulmonary rehabilitation training on lung function in elderly patients after surgery for intertrochanteric fractures of the femur: a randomized controlled trial. Eur J Med Res, 2025, 30(1): 381.
18. Zhao C, Bi Y. Effect of lung rehabilitation exercise on the postoperative respiratory function of patients with lung cancer. Asian J Surg, 2022, 45(10): 2012.
19. Cheng X. Effects of lung rehabilitation therapy in improving respiratory motor ability and alleviating dyspnea in patients with lung cancer after lobectomy: a clinical study. Altern Ther Health Med, 2022, 28(3): 18-23.
20. Hu Y, Cheng Q, Guo Q. The role of preoperative lung rehabilitation training combined with nutritional intervention on surgical tolerance and accelerated recovery indicators in patients with moderate to severe COPD complicated with lung cancer. Front Surg, 2025, 12: 1667085.
21. Ye X. Surgery plus ablation (SPA): an emerging treatment modality for multiple ground glass nodule-like lung cancer. J Cancer Res Ther, 2025, 21(6): 1095-1097.
22. Zhao H, Wu J, Hu W, et al. Minimally invasive lung resection combined with CT guided percutaneous microwave ablation for the treatment of lung cancer: diagnosis of postoperative nerve damage. Arch Physiol Biochem, 2025. Epub ahead of print.
23. Bourdas DI, Tsakiris TS, Pavlakis KI, et al. Repeated apneas and hypercapnic ventilatory response before and after apnea training. Aerosp Med Hum Perform, 2015, 86(1): 27-33.
24. 張海廷, 段洪連, 王維. 屏氣訓練在腦缺氧預適應中的可行性及作用機制探討. 神經損傷與功能重建, 2025, 20(10): 587-590.Zhang HT, Duan HL, Wang W. Exploring the feasibility and mechanisms of breath-holding training in cerebral hypoxia preconditioning. Neural Inj Funct Reconstruc, 2025, 20(10): 587-590.
25. Luo X, Chen G, Zhang S, et al. Visualized breath-hold training for reducing respiratory motion artifacts in liver dynamic contrast-enhanced magnetic resonance imaging. Quant Imaging Med Surg, 2025, 15(8): 7090-7100.
26. Allinger J, Bouyeure A, Noulhiane M, et al. Monitoring the breath-hold training load during an ecological session: a pilot study. Int J Sports Med, 2024, 45(11): 837-843.
27. Yang K, Wang WB, Yu ZH, et al. Eight weeks of dry dynamic breath-hold training results in larger spleen volume but does not increase haemoglobin concentration. Front Physiol, 2022, 13: 925539.
28. Mayr NA, Borm KJ, Kalet AM, et al. Reducing cardiac radiation dose from breast cancer radiation therapy with breath hold training and cognitive behavioral therapy. Top Magn Reson Imaging, 2020, 29(3): 135-148.
29. Joulia F, Steinberg JG, Faucher M, et al. Breath-hold training of humans reduces oxidative stress and blood acidosis after static and dynamic apnea. Respir Physiol Neurobiol, 2003, 137(1): 19-27.
30. Guézennec J, Correa D, Billaut F. Influence of the combination of end-expiratory breath-hold training and inspiratory muscle training on performance in artistic swimmers. Appl Physiol Nutr Metab, 2026, 51: 1-12.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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