Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy

Masato Hayashi, Hiroya Takeuchi, Rieko Nakamura, Koichi Suda, Norihito Wada, Hirofumi Kawakubo, Yuko Kitagawa

Research output: Contribution to journalArticle

Abstract

Background: Esophagectomy is associated with a high risk of postoperative complications, and the respiratory complications are the most common. Therefore, stratification of patients based on preoperative risk factors is essential. This study aimed to identify the risk of postoperative pneumonia (POP) based on the preoperative factors and determine the optimal perioperative surgical management strategy. Methods: This retrospective study involved 207 patients who underwent esophagectomy. The patients were divided into two groups, namely, with POP and without POP. To identify the risk factors for POP, the pre- and perioperative characteristics were analyzed. A receiver operating characteristics curve was used to determine a cutoff value of 2.40 L for the forced expiratory volume in 1 s (FEV1.0) and the cohort was divided into a high- and low-FEV1.0 group. A second analysis was then performed to determine the optimal surgical management for patients at a high risk for POP. Results: POP occurred in 45 (21.7%) patients. A multiple logistic regression analysis showed that FEV1.0 was significantly lower in the POP (+) group (P = 0.020); thus, a low FEV1.0 was found to be a risk factor for POP. Multiple logistic regression analysis showed that open thoracotomy was a significant risk factor for POP in low FEV1.0 patients (P = 0.013). Conclusions: A low FEV1.0 and an open thoracotomy are risk factors for POP. Therefore, patients with low FEV1.0 should be managed carefully and video-assisted thoracic surgery should be considered.

Original languageEnglish
JournalEsophagus
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Keywords

  • Esophageal neoplasm
  • Esophagectomy
  • Pneumonia

ASJC Scopus subject areas

  • Gastroenterology

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