"Liuzijue" Qigong training enhances early pulmonary function recovery after esophageal cancer surgery

doi:10.4240/wjgs.v17.i12.113408

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Dec 27, 2025 (publication date) through Dec 25, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Dec 27, 2025; 17(12): 113408
Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.113408

"Liuzijue" Qigong training enhances early pulmonary function recovery after esophageal cancer surgery

Yu Bai, Zhi-Long Zhang, Lei Qiao, Ling-Ling Shi, Jian Wang, Hui Nian, Qian-Cheng Du, Zhi-Hao Tian, Zi-Long Yao, Yi-Bin Wu

Yu Bai, Zhi-Hao Tian, Yi-Bin Wu, Intensive Care Unit, Shanghai Xuhui Central Hospital, Shanghai 200031, China

Zhi-Long Zhang, Jian Wang, Hui Nian, Qian-Cheng Du, Department of Thoracic Surgery, Shanghai Xuhui Central Hospital, Shanghai 200031, China

Lei Qiao, Department of Rehabilitation Medicine, Shanghai Xuhui Central Hospital, Shanghai 200031, China

Ling-Ling Shi, Zi-Long Yao, Department of Nursing, Shanghai Xuhui Central Hospital, Shanghai 200031, China

Author contributions: Bai Y was responsible for conceptualization, methodology, formal analysis, writing original draft, and project administration; Zhang ZL was responsible for resources, data curation, investigation (surgical cohort recruitment), and validation; Qiao L was responsible for methodology (rehabilitation protocol design), supervision, writing review and editing; Shi LL and Yao ZL were responsible for investigation (Qigong training implementation), patient follow-up, and visualization; Wang J, Nain H and Tian ZH were responsible for investigation (perioperative data collection), resources, and validation; Du QC was responsible for formal analysis (statistics), software, and data curation; Wu YB was responsible for conceptualization, funding acquisition, supervision, writing review and editing; all authors have read and approved the final manuscript.

Supported by Xuhui District Health Commission, No. SHXH202214.

Institutional review board statement: The study protocol was approved by Ethics Committee of Shanghai Xuhui Central Hospital.

Informed consent statement: This retrospective study exclusively employed anonymized clinical data obtained from electronic medical records and did not include the collection or analysis of human biological samples, such as blood, tissues, or other biospecimens. The Ethics Committee of Shanghai Xuhui Central Hospital granted a waiver for the requirement of individual informed consent.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: The dataset generated and analyzed during the course of this study is available from the corresponding author upon reasonable request. Due to privacy and ethical constraints, the original raw data cannot be publicly shared. However, de-identified data may be made accessible upon approval by the institutional ethics committee.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Yi-Bin Wu, MD, Associate Chief Physician, Director, Intensive Care Unit, Shanghai Xuhui Central Hospital, No. 366 Longchuan North Road, Xuhui District, Shanghai 200031, China. didi_2001_328@sina.com

Received: August 25, 2025
Revised: September 13, 2025
Accepted: November 7, 2025
Published online: December 27, 2025
Processing time: 122 Days and 16.2 Hours

Abstract

BACKGROUND

Esophageal cancer surgery is associated with a high risk of postoperative pulmonary complications, particularly pneumonia. Although conventional respiratory rehabilitation strategies – such as preoperative inspiratory muscle training – have demonstrated limited efficacy, the low-intensity traditional Chinese Qigong practice "Liuzijue" (Six-Character Formula) shows promise. However, robust clinical evidence supporting its use in patients undergoing esophagectomy remains lacking.

AIM

To evaluate the effects of early postoperative "Liuzijue" training on pulmonary function and pneumonia incidence following radical esophagectomy.

METHODS

This retrospective study included 306 patients who underwent esophagectomy. The control group (n = 163) received standard care, consisting of abdominal breathing, incentive spirometry, and early ambulation. The intervention group (n = 143) received the same standard care plus twice-daily "Liuzijue" training for 14 days. Primary outcomes were the incidence of pneumonia (defined by Centers for Disease Control and Prevention criteria) and changes (Δ) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), and maximum voluntary ventilation (MVV) from baseline to postoperative day 14.

RESULTS

The "Liuzijue" intervention was associated with a significantly lower incidence of pneumonia (11.9% vs 24.5%, P = 0.005; relative risk = 0.48). Significant improvements were observed in ΔFVC (+502.1 mL vs +326.5 mL, P < 0.001), ΔFEV₁ (+701.7 mL vs +434.4 mL, P < 0.001), and ΔMVV (+19.4 L/minute vs +14.4 L/minute, P < 0.001). Absolute FEV₁ values on postoperative day 14 were higher in the intervention group (2270.8 mL vs 2066.1 mL, P = 0.021), along with significantly lower Borg dyspnea/fatigue scores (P = 0.045). No significant differences were observed in changes in diffusing capacity of the lung for carbon monoxide, total lung capacity, or 6-minute walk distance.

CONCLUSION

Early initiation of "Liuzijue" training after esophagectomy is associated with reduced pneumonia incidence and accelerated recovery of key pulmonary function parameters. These findings support the integration of "Liuzijue" into enhanced recovery after surgery protocols for esophageal cancer patients.

Keywords: Esophagectomy; Postoperative pulmonary complications; Pulmonary function; Enhanced recovery after surgery; "Liuzijue" Qigong

Core Tip: Early postoperative "Liuzijue" Qigong training significantly reduces the risk of postoperative pneumonia and accelerates the recovery of core pulmonary function parameters in patients undergoing radical esophagectomy. As a low-intensity intervention, it integrates coordinated breathing techniques with vocalization to enhance postoperative respiratory muscle function. This approach is particularly well-suited for incorporation into enhanced recovery after surgery pathways, offering a safe, feasible, and effective adjunct to conventional respiratory rehabilitation strategies.