Assessment of a predictive score for pulmonary complications in cancer patients after esophagectomy

Abstract

BACKGROUND: Esophagectomy is a very important method for the treatment of resectable esophageal cancer, which carries a high rate of morbidity and mortality. This study was undertaken to assess the predictive score proposed by Ferguson et al for pulmonary complications after esophagectomy for patients with cancer. METHODS:The data of patients who admitted to the intensive care unit after transthoracic esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College between September 2008 and October 2010 were retrospectively reviewed. RESULTS:Two hundred and seventeen patients were analyzed and 129 (59.4%) of them had postoperative pulmonary complications. Risk scores varied from 0 to 12 in all patients. The risk scores of patients with postoperative pulmonary complications were higher than those of patients without postoperative pulmonary complications (7.27±2.50 vs. 6.82±2.67; P=0.203). There was no significant difference in the incidence of postoperative pulmonary complications as well as in the increase of risk scores (χ 2 =5.477, P=0.242). The area under the curve of predictive score was 0.539±0.040 (95%CI 0.461 to 0.618; P=0.324) in predicting the risk of pulmonary complications in patients after esophagectomy. CONCLUSION:In this study, the predictive power of the risk score proposed by Ferguson et al was poor in discriminating whether there were postoperative pulmonary complications after esophagectomy for cancer patients.

Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients

“…There was no difference in the occurrence of ARDS, atelectasis, pleural effusions and respiratory failure in these two groups [22]. The literature does not describe a significant difference in the occurrence of RC in esophageal resection performed by the transthoracic or transhiatal approach [14]. Wan et al did not observe a significant decrease in the incidence of RC following the thoracolaparoscopic method with cervical anastomosis compared to a control group of patients managed by classical McKeown esophagectomy [22].…”

Preventable readmission to intensive care unit in critically ill cancer patients

“…A larger sample study involving 229,375 patients conducted in U.S. demonstrated readmission to ICU was associated with a higher risk of hospital mortality and a longer hospital stay. [5] Therefore, One-year survival between readmission patients who were preventable or not (66.8% vs. 100%, log rank=1.668, P=0.196). There was a trend that patients who were preventable had longer 1-year survival.…”

“…Nishi et al [1][2][3][4][5] reported that readmission to intensive care unit (ICU) after discharge to ward was associated with longer length of stay (LOS) and increased hospital mortality. As a result, readmission rate was set as a quality indicator of ICU and hospital.…”

Complications of the surgical treatment of esophageal cancer and microbiological analysis of the respiratory tract

“…8,9 ). The most frequent cause of death following esophagectomy are respiratory complications, the incidence of which increases with age, chronic nicotine use, malnutrition, pulmonary dysfunction and immunodeficiency 10,11 . Other factors which affect the development of respiratory complications include duration of surgery and perioperative blood loss, decreased forced expiratory volume (FEV) 1 on spirometry, neoadjuvant oncological therapy and the incidence of anastomotic fistula 12,13 .…”