With regard to the outcomes, it was found that the occurrence of PPCs and mean LOS
tended to be lower in patients who received enforced mobilisation compared with patients
who received traditional mobilisation, whereas re-admission rate and change in 6MWT did
not differ between the two groups. When patients who underwent oesophageal resection were
excluded from the analyses, a significant decrease in PPCs was found after implementation of
enforced mobilisation. This is of clinical importance as PPCs are related to poorer outcome,
including increased morbidity and mortality [19]. This finding is in line with a review by
Nielsen et al. which concluded that postoperative mobilisation is important for improving
pulmonary outcome, thereby reducing the risk of PPCs [20]. To the best of the authors’
knowledge, the benefit of enforced mobilisation over traditional mobilisation on PPCs has not
been studied previously. It is believed that the effectiveness of early enforced mobilisation
will be most pronounced following complex (mostly ‘open’) surgery for gastrointestinal
cancer, as these patients are at high risk of developing PPCs, creating a window of
opportunity for enforced mobilisation to prevent PPCs.