Early Postoperative Atelectasis After Liver Cancer Surgery Affects Exercise Tolerance One Month Post-surgery: A Retrospective Cohort Study

Introduction Surgical resection is a curative treatment for liver cancer. Postoperative atelectasis is a common complication, but its impact on functional recovery, specifically exercise tolerance, remains unclear. Exercise tolerance, measured by the 6-minute walk test (6MWT), is a key predictor of postoperative outcomes. This study aimed to determine the impact of postoperative atelectasis on the change in exercise tolerance one month after liver cancer surgery. Methods This retrospective cohort study included 55 patients undergoing primary liver cancer surgery between 2019 and 2023. The primary outcome was the change in 6-minute walk distance (Δ6MWD) from baseline to one month post-surgery. Atelectasis was diagnosed via CT scan one week postoperatively. We used inverse probability of treatment weighting (IPW) to adjust for confounding variables between the atelectasis and non-atelectasis groups. Results Atelectasis was present in 22 of 55 patients (40.0%). The mean Δ6MWD was significantly worse in the atelectasis group (-41.5 m) versus the non-atelectasis group (-8.0 m, p=0.002). After IPW adjustment, which successfully balanced covariates (all standardized mean differences < 0.1), atelectasis remained significantly associated with a greater decline in 6MWD (adjusted coefficient: -32.5, 95% CI: -61.1 to -3.4; p=0.026), exceeding the minimal clinically important difference. Conclusion This is the first study to show that postoperative atelectasis significantly impairs exercise tolerance one month after liver cancer surgery. This study is limited by its small sample size, single-center design, and short follow-up period. However, our findings highlight the need for effective atelectasis prevention strategies and suggest that monitoring exercise tolerance is crucial for optimizing postoperative recovery in this population.