©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
"Liuzijue" Qigong training enhances early pulmonary function recovery after esophageal cancer surgery
Yi-Bin Wu, Zi-Long Yao, Zhi-Hao Tian, Qian-Cheng Du, Hui Nian, Jian Wang, Ling-Ling Shi, Lei Qiao, Zhi-Long Zhang, Yu Bai
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.
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 22.8 Hours
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.
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.
