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The drive to increase lung cancer resection rates continues and with it, the need to reduce the perioperative risks and improve post-operative quality of life for an increasingly high-risk cohort of patients. Post-operative pulmonary complications are common and are associated with poorer long-term outcomes (1). The recent ERAS guidelines highlight the importance of preoperative rehabilitation, or prehabilitation, in reducing hospital length of stay and postoperative pulmonary complications (2). However, they note the paucity of high-quality evidence in how best to employ it. We have previously interrogated the evidence for prehabilitation in an attempt to answer the key questions on how to run the ideal programme (3). We read with interest two recently published randomised controlled trials on the topic to see if they can provide evidence to clarify the answers to some of these. Laurent et al. performed an open label randomised control trial in 26 patients to evaluate the effect of preoperative respiratory muscle endurance training with change in minute volume achievable and endurance time, a kind of “bleep test” for breathing, as the primary outcome (4). Their patients all underwent anatomical resection for lung cancer at the end of the 3 weeks. Liu et a l . report on a s ingle bl ind randomised controlled trial of 73 patients undergoing a multimodality rehabilitation program for 2 weeks prior to lung cancer resection (5).

Prehabilitation in lung cancer resection—are we any closer to the ideal program?