M. Hayashi1, H. Takeuchi1, F. Kazumasa1, R. Nakamura1, K. Suda1, H. Kawakubo1, N. Wada1, Y. Kitagawa1 1Keio University School Of Medicine,Department Of Surgery,Shinjyuku, TOKYO, Japan
Introduction:
It is reported that transthoracic esophagectomy for esophageal cancer is associated with higher risk than other gastrointestinal surgeries and its postoperative complication rate is up to about 45%. Among the complications, respiratory complication is most common and it may cause perioperative death. In this study, risk factors of postoperative pneumonia (? Clavien-Dindo’s Classification II ) was examined.
Methods:
From January 2012 to April 2016, we examined 176 patients who underwent transthoracic esophagectomy. From postoperative period to discharge, we divided the cases into two groups : postoperative pneumonia’s group and no postoperative pneumonia’s group, and risk factors of postoperative pneumonia were examined. Postoperative pneumonia was diagnosed by detecting fever, high inflammation, and x-ray or computed tomography (CT) showing infiltrative shadow retrospectively. Age at the surgery, preoperative forced expiratory volume in 1second (FEV 1.0), % vital capacity (%VC), preoperative body mass index (BMI), and preoperative endoscopic treatment were examined whether they are risk factors of postoperative pneumonia or not. Referring to the average of postoperative pneumonia’s group FEV 1.0 : 2.56 L, we defined 2.40 L as cutoff value of preoperative FEV 1.0. Using the number, we divided FEV1.0 higher group and lower group.
Results:
Among 176 cases, male was 144 (81.8 %) and female was 32 (18.2 %). The mean age at the operation was 64.2. Preoperative mean FEV1.0 was 2.71 L, and preoperative mean %VC was 102.2 %. Postoperative pneumonia was 42 (23.9 %). In postoperative pneumonia group’s mean FEV1.0 was 2.56 L and no postoperative pneumonia group’s mean FEV1.0 was 2.76 L. We could not recognize statistically-significant difference among age at the surgery, preoperative %VC, preoperative BMI, or preoperative endoscopic treatment. About preoperative FEV1.0, p value was 0.04 and odds ratio was 0.49. It suggests that less than 2.40 L FEV1.0 tends to have postoperative pneumonia. In cases which FEV1.0 was less than 2.40, postoperative pneumonia was 19 (11.0 %).
Conclusion:
It is thought that preoperative FEV1.0 was risk factor of postoperative pneumonia in patients who underwent transthoracic esophagectomy..From this study, we should consider to use stronger preoperative respiratory training
in cases which preoperative FEV1.0 is less than 2.40 L.