Assessment of breathing mechanics in oesophageal cancer survivors
File(s)
Author(s)
Tukanova, Karina
Type
Thesis
Abstract
Background: Oesophageal cancer survivors commonly experience persistent functional limitations and impaired health-related quality of life (HRQoL), yet the physiological mechanisms underlying these outcomes remain poorly understood. Conventional pulmonary function tests (PFTs) may not fully capture postoperative respiratory dysfunction. This study aimed to establish the reliability of a three-dimensional (3D) motion capture protocol for quantifying thoracoabdominal breathing mechanics and to examine their association with long-term morbidity following oesophagectomy.
Methods: A comprehensive 89-marker protocol was implemented, and the inter-session test-retest reliability was established in 22 healthy controls. This protocol was then applied to 18 long-term oesophageal cancer survivors. Simultaneous spirometry and movement data were acquired during maximal respiratory manoeuvres. Thoracoabdominal volume, compartmental contributions, and unilateral asymmetry were quantified. Group comparisons were adjusted for confounders, and correlations between objective respiratory measures and validated HRQoL scores were assessed.
Results: The motion capture protocol demonstrated high reliability. Compared to controls, patients had significantly reduced spirometry lung volumes and significantly impaired HRQoL across multiple domains (p<0.05). However, spirometry values did not correlate with any HRQoL subscales. In contrast, patients exhibited significantly greater unilateral thoracoabdominal asymmetry during slow expiratory manoeuvres compared with healthy controls (p = 0.039). This asymmetry was significantly associated with greater symptom burden, including trouble with coughing (ρ = 0.550, p = 0.018), eating restrictions (ρ = 0.599, p = 0.009), and insomnia (ρ = 0.531, p = 0.023).
Conclusion: Long-term morbidity following oesophagectomy appears to be associated with alterations in breathing mechanics, particularly unilateral thoracoabdominal asymmetry, rather than reductions in total thoracoabdominal movements. These findings highlight a potentially important and measurable aspect of postoperative respiratory function and suggest that future rehabilitation strategies may benefit from addressing breathing pattern asymmetries to support improvements in functional outcomes and HRQoL.
Methods: A comprehensive 89-marker protocol was implemented, and the inter-session test-retest reliability was established in 22 healthy controls. This protocol was then applied to 18 long-term oesophageal cancer survivors. Simultaneous spirometry and movement data were acquired during maximal respiratory manoeuvres. Thoracoabdominal volume, compartmental contributions, and unilateral asymmetry were quantified. Group comparisons were adjusted for confounders, and correlations between objective respiratory measures and validated HRQoL scores were assessed.
Results: The motion capture protocol demonstrated high reliability. Compared to controls, patients had significantly reduced spirometry lung volumes and significantly impaired HRQoL across multiple domains (p<0.05). However, spirometry values did not correlate with any HRQoL subscales. In contrast, patients exhibited significantly greater unilateral thoracoabdominal asymmetry during slow expiratory manoeuvres compared with healthy controls (p = 0.039). This asymmetry was significantly associated with greater symptom burden, including trouble with coughing (ρ = 0.550, p = 0.018), eating restrictions (ρ = 0.599, p = 0.009), and insomnia (ρ = 0.531, p = 0.023).
Conclusion: Long-term morbidity following oesophagectomy appears to be associated with alterations in breathing mechanics, particularly unilateral thoracoabdominal asymmetry, rather than reductions in total thoracoabdominal movements. These findings highlight a potentially important and measurable aspect of postoperative respiratory function and suggest that future rehabilitation strategies may benefit from addressing breathing pattern asymmetries to support improvements in functional outcomes and HRQoL.
Version
Open Access
Date Issued
2025-07-30
Date Awarded
2026-03-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Mcgregor, Alison
Markar, Sheraz
Hanna, George
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)