Dysphagia after esophagectomy is a major risk factor for aspiration pneumonia, thus preoperative assessment of swallowing function is important. The maximum phonation time (MPT) is a simple indicator of phonatory function and also correlates with muscle strength associated with swallowing. This study aimed to determine whether preoperative MPT can predict postoperative aspiration pneumonia. The study included 409 consecutive patients who underwent esophagectomy for esophageal cancer between 2017 and 2021. Pneumonia detected by routine computed tomography on postoperative days 5–6 was defined as early-onset pneumonia, and pneumonia that developed later (most often aspiration pneumonia) was defined as late-onset pneumonia. The correlation between late-onset pneumonia and preoperative MPT was investigated. Patients were classified into short MPT (<15 seconds for males and <10 seconds for females, n = 156) and normal MPT groups (≥15 seconds for males and ≥10 seconds for females, n = 253). The short MPT group was significantly older, had a lower serum albumin level and vital capacity, and had a significantly higher incidence of late-onset pneumonia (18.6 vs. 6.7%, P < 0.001). Multivariate analysis showed that short MPT was an independent risk factor for late-onset pneumonia (odds ratio: 2.26, P = 0.026). The incidence of late-onset pneumonia was significantly higher in the short MPT group (15.6 vs. 4.7%, P = 0.004), even after propensity score matching adjusted for clinical characteristics. MPT is a useful predictor for late-onset pneumonia after esophagectomy.
Background This retrospective study aimed to demonstrate surgical operative approach of total pelvic exenteration combined with sacral resection with rectal cancer and elucidate the relationships between the level of sacral resection and short-term outcomes. Methods Twenty cases were selected. Data regarding sex, age, body mass index, neoadjuvant therapy, location of sacral resection (“Upper” or “Lower” relative to the level between the 3rd and 4th sacral segment), operative time, bleeding, and curability (R0/R1) were collected and compared to determine their association with complications exhibiting a Clavien-Dindo grade III. Results The complication rate was significantly higher for recurrent cancers (n = 10, 76.9%) than for primary cancers (n = 1, 14.3%) ( P = .007), and for “Upper” resection (n = 8, 72.7%) than for “Lower” resection (n = 3, 33.3%) ( P = .078). Significant differences were observed when complication rates for “Lower” and primary cancer resection (n = 3, .0%) were compared between “Upper” and recurrent cancers (n = 8, 100.0%) ( P = .007). Conclusion In patients with recurrent rectal cancer, “Upper” sacral resection during total pelvic exenteration is associated with a high complication rate, highlighting the need for careful monitoring.
Background
This retrospective study aimed to elucidate the relationships between short-term outcomes following total pelvic exenteration combined with sacral resection (TPES) and operative techniques in patients with rectal cancer.
Methods
Data regarding sex, age, body mass index, neoadjuvant therapy, location of sacral resection (“Upper” or “Lower” relative to the level between the 3rd and 4th sacral segment), operative time, bleeding, and curability (R0/R1) were collected and compared to determine their association with complications exhibiting a Clavien–Dindo grade higher than III.
Results
The complication rate was significantly higher for recurrent cancers than for primary cancers (p = 0.007), and for “Upper” resection than for “Lower” resection (p = 0.078). Significant differences were observed when complication rates for “Upper” and “Lower” resection were compared between primary and recurrent cancers (p = 0.007).
Conclusion
In patients with recurrent rectal cancer, “Upper” sacral resection during TPES is associated with a high complication rate, highlighting the need for careful monitoring.
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