Clinical value of a prophylactic minitracheostomy after esophagectomy: analysis in patients at high risk for postoperative pulmonary complications

Abstract

BackgroundThe aim of this study is to evaluate the clinical value of a prophylactic minitracheostomy (PMT) in patients undergoing an esophagectomy for esophageal cancer and to clarify the indications for a PMT.MethodsNinety-four patients who underwent right transthoracic esophagectomy for esophageal cancer between January 2009 and December 2013 were studied. Short surgical outcomes were retrospectively compared between 30 patients at high risk for postoperative pulmonary complications who underwent a PMT (PMT group) and 64 patients at standard risk without a PMT (non-PMT group). Furthermore, 12 patients who required a delayed minitracheostomy (DMT) due to postoperative sputum retention were reviewed in detail, and risk factors related to a DMT were also analyzed to assess the indications for a PMT.ResultsPreoperative pulmonary function was lower in the PMT group than in the non-PMT group: FEV1.0 (2.41 vs. 2.68 L, p = 0.035), and the proportion of patients with FEV1.0% <60 (13.3% vs. 0%, p = 0.009). No between-group differences were observed in the proportion of patients who suffered from postoperative pneumonia, atelectasis, or re-intubation due to respiratory failure. Of the 12 patients with a DMT, 11 developed postoperative pneumonia, and three required re-intubation due to severe pneumonia. Multivariate analysis revealed FEV1.0% <70% and vocal cord palsy were independent risk factors related to a DMT.ConclusionA PMT for high-risk patients may prevent an increase in the incidence of postoperative pneumonia and re-intubation. The PMT indications should be expanded for patients with vocal cord palsy or mild obstructive respiratory disturbances.

Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients

“…[29–31] Patients are prone to sputum retention, atelectasis, and pneumonia if postoperative pain is poorly controlled although a previous study did not find any difference with respect to the incidence of postoperative respiratory complication because of the smaller sample size. [32] Whether insufflating warmed, humidified CO 2 is clinically advantageous for patients undergoing laparoscopic colorectal surgery remains to be elucidated. Besides, it is generally accepted that the pressure of CO 2 used for the pneumoperitoneum may also contribute to peritoneal injury.…”

Outcomes of Esophageal Cancer after Esophagectomy in the Era of Early Injection Laryngoplasty

“…The resulting breathy voice and aspiration of liquid impair quality of life and increase the risk of pneumonia. UVFP after esophagectomy was also reported to increase the risk of severe weight loss and pulmonary consequences [4,6,10]. Previous reports claimed that the risk factors include lymphadenectomy around the right recurrent laryngeal nerve (RLN), cervical esophagus mobilization and cervical anastomosis [4,[19][20][21][22].…”

“…Although some of the UVFP patients eventually recovered through compensation or reinnervation, post-operative care remains a great challenge. Routine jejunostomy tube feeding or prophylactic tracheostomy has been reported to prevent such consequences [10,23,24], but quality of life is substantially impaired with these management methods.…”

“…Patients might suffer from persistent dysphonia, aspiration, and impaired pulmonary clearance from ineffective cough during this period of observation. Under some circumstances, tube feeding or tracheostomy might be necessary for nutrition and to prevent aspiration pneumonia [8][9][10]. Therefore, these potential consequences may make cancer surgeons hesitate to perform radical lymph node dissections.…”

Evaluation of the effectiveness of preoperative outpatient pulmonary preparation in patients undergoing esophageal surgery

“…This approach is aimed at partially removing the esophageal body extensively compromised by the destruction of the myenteric plexuses that are responsible for motility and contraction of the esophagus [5]. However, although surgery is the therapeutic procedure that provides the best outcomes in these patients, it can cause important pulmonary complications that delay the recovery of the patients and even increase mortality [6].…”