Incidence and Risk Factors for Respiratory Complications in Patients Undergoing Esophagectomy for Malignancy: A NSQIP Analysis

Molena, Daniela; Mungo, Benedetto; Stem, Miloslawa; Lidor, Anne O.

doi:10.1053/j.semtcvs.2014.12.002

Cited by 58 publications

(52 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although oesophagogastric resection remains the mainstay of curative treatment for these cancers, it is associated with significant morbidity. In particular, anastomotic leaks occur in up to 20 per cent of patients, pulmonary complications in up to 35 per cent and cardiovascular complications in up to 15 per cent. These complications result in increased duration of hospital stay and perioperative mortality.…”

Section: Introductionmentioning

confidence: 99%

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Saunders

Yanni

Dorrington

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

Background: Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear. Methods: All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien-Dindo classification (grades 0-V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan-Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination. Results: Some 1100 patients were included, with a median age of 69 (range 28-92) years; 48⋅1 per cent had stage III disease and cancer recurred in 428 patients (38⋅9 per cent). Complications of grade III or higher occurred in 244 patients (22⋅2 per cent). The most common complications were pulmonary (29⋅9 per cent), with a 13⋅0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10⋅0 and 9⋅6 per cent respectively. Patients with a grade III-IV leak did not have significantly reduced overall survival compared with those who had grade 0-I complications. However, patients with grade III-IV non-leak-related complications had reduced median overall survival (19⋅7 versus 42⋅7 months; P < 0⋅001) and disease-free survival (18⋅4 versus 36⋅4 months; P < 0⋅001). Cox regression analysis identified age, tumour stage, resection margin and grade III-IV non-leak-related complications as independent predictors of poor overall and disease-free survival. Conclusion: Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival. Statistical analysisContinuous variables are described as median (i.q.r. or range) or mean(s.d.), and were compared using the Mann-Whitney U test and Student's t test respectively. The χ 2 test was used for analysis of discrete data. OS was

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Saunders

Yanni

Dorrington

et al. 2019

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Postoperative pulmonary complications rates in head and neck reconstructive patients have been variously at 7.1% to 32.7% [ 13 – 15 ]. The increased incidences of POP in head and neck surgery have been related to advanced ages, male gender, tracheotomy, long operative time and delayed mobilization [ 10 , 13 , 16 ]. However, as essential parts of head and neck cancer, a paucity of data exists regarding POP in OC patients.…”

Section: Introductionmentioning

confidence: 99%

Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

ObjectivePostoperative pneumonia (POP) is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC) surgery.MethodsPerioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later.ResultsThe incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP.ConclusionSeveral perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.

show abstract

“…They found that major pulmonary complications occurred in 15.9% and that age was an independent risk factor for major pulmonary complications; the incidence of major pulmonary complications was 25% in patients ≥70 years old and 13% in those <70 years old (p = 0.006). Molena et al evaluated the incidence and risk factors for respiratory complications in 2945 patients who underwent esophagectomy for esophageal malignancies between 2005 and 2012 20) . They found that advanced age was an independent risk factor for developing respiratory complications; the incidence of respiratory complications was 20.59% in patients <60 years old (hazard ratio [HR] as reference), 22.78% in those 60-69 years old (HR: 1.11, 95% CI: 0.94-1.31), 26.71% in those 70-79 years old (HR: 1.30, 95% CI: 1.09-1.54), and 27.94% in those ≥80 years old (HR: 1.36, 95% CI: 1.01-1.84).…”

Section: Discussionmentioning

confidence: 99%

The Oral Health Assessment Tool score is an independent risk factor for postoperative pneumonia after esophagectomy for esophageal cancer

Tamagawa

Aoyama

Hara

et al. 2019

Ann. Cancer Res. Therap.

View full text Add to dashboard Cite

Background: The present study explored whether or not the Oral Health Assessment tool (OHAT) score is a risk factor of postoperative pneumonia after esophagectomy for esophageal cancer. Methods: This study included 47 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for postoperative pneumonia. Results: Postoperative pneumonia was found in 18 of the 47 patients (38.3%). Among the various factors examined (age, gender, preoperative chemotherapy status, operative type, operative duration, blood loss, lymph node dissection, alcohol habit, OHAT score), the OHAT score (p = 0.006) and age (p = 0.040) were identified as significant independent risk factors for postoperative pneumonia in univariate and multivariate analyses. The incidence of postoperative pneumonia was 5% (1 of 20) in the OHAT ≤2 group and 51.9% (14 of 27) in the OHAT ≥3 group. Conclusion: The OHAT score is a risk factor for postoperative pneumonia in patients who have undergone curative esophagectomy for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

show abstract

Incidence and Risk Factors for Respiratory Complications in Patients Undergoing Esophagectomy for Malignancy: A NSQIP Analysis

Cited by 58 publications

References 18 publications

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases

The Oral Health Assessment Tool score is an independent risk factor for postoperative pneumonia after esophagectomy for esophageal cancer

Contact Info

Product

Resources

About