Risk factors for postoperative respiratory complications following esophageal cancer resection

Abstract

Abstract. The development of surgical and postoperative management techniques has improved the treatment outcomes of esophageal cancer resection. However, respiratory morbidity is still the most frequent complication after esophagectomy. The objective of the present study was to identify risk factors for respiratory complications following resection for esophageal cancer. This study included 96 patients with esophageal cancer who had undergone esophagectomy with lymph node dissection. The patients were divided into 2 groups according to the presence (20 patients, 17 had pneumonia and 3 had acute respiratory distress syndrome) or absence (76 patients) of postoperative respiratory complications (PRC). The two groups were compared with respect to their preoperative clinical variables, such as age, body mass index, smoking history, serum albumin, serum C-reactive protein (CRP), number of lymphocytes, %VC, FEV1.0% and FEV1.0. Furthermore, multiple logistic regression analyses were used to estimate relative risk factors for respiratory complications. Results of the univariate analysis showed that smoking history (+/-, patients with PRC, 19/1 and without PRC, 53/23), serum CRP (≥1.0 mg/ dl/<1.0 mg/dl, patients with PRC, 6/14 and without PRC, 6/70) and FEV1.0% (≥60%/<60%, patients with PRC, 16/4 and without PRC, 73/3) were significantly different between the two groups. Multiple logistic regression analysis showed that FEV1.0% was the strongest predictor of PRC. FEV1.0%, serum CRP and smoking history are reliable predictors of the risk of respiratory complications following esophageal cancer resection. For patients with these factors, perioperative management for the prevention of postoperative respiratory complications should be considered.

Extrapleural Pneumonectomy After Induction Chemotherapy: Perioperative Outcome in 251 Mesothelioma Patients From Three High-Volume Institutions

“…Preoperative CRP was identified as a predictor of PE, an interesting marker also representing tumor activity, which has been previously described as an independent prognosticator also for survival by the Vienna group [24] and is also one item of a four-point selection algorithm score in Zurich used for patient selection for multimodality treatment (unpublished data). CRP as a predictive marker for pulmonary adverse events, for instance after esophageal cancer resection, has been investigated in a recent study by Shiozaki and colleagues [25] reporting elevated serum CRP levels in 30% of patients with postoperative respiratory adverse events. Elevated perioperative CRP levels even after induction chemotherapy in MPM patients might integrate several adverse factors like tumor aggressiveness, enhanced tumor burden, and disease progression together, resulting in poor perioperative treatment outcome and risk of postoperative morbidity.…”

Preoperative chemotherapy in patients with resectable esophageal carcinoma: a single center Phase II study

“…Pulmonary complications were the leading cause of death in those patients. Well-known factors, such as history of smoking, poor nutritional status, stage of disease and age were often related to pulmonary complications (17)(18)(19)(20). In our study, all patients with squamous cell EC were current or former heavy smokers, 42% of patients had pretreatment weight loss of >10 and 87% had stage III disease.…”

The preoperative serum C-reactive protein level is a useful predictor of surgical site infections in patients undergoing appendectomy

“…Several clinical studies have revealed that the preoperative CRP level is associated with postoperative complications [7,8], because it may indicate the preoperative immune function. The postoperative CRP level is also associated with postoperative complications [9,10] and may, therefore, be an indicator of immunosuppression induced by surgical stress.…”