The effect of neoadjuvant chemoradiotherapy on airway colonization and postoperative respiratory complications in patients undergoing oesophagectomy for oesophageal cancer

Abstract

Respiratory complication is one of the important postoperative complications of oesophageal cancer. The aim of this study was to evaluate whether neoadjuvant chemotherapy before surgery is effective for postoperative respiratory complications. In this study, patients with oesophageal cancer were divided into two group: one with neoadjuvant therapy and the other without neoadjuvant therapy. Before surgery, they all underwent bronchoscopy and bronchoalveolar lavage. We evaluated respiratory complications and the effects of preoperative neoadjuvant therapy. Forty patients (M/F = 23/17 and mean age 61 years) were enrolled in this study. Twenty-two cases had cancer in the middle part and 18 in the lower part of the oesophagus. Significant correlation was observed between the number of positive micro-organism and difficulty in weaning and receiving neoadjuvant therapy. But no significant correlation was found between neoadjuvant therapy and respiratory complications.

Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers

“…). The sensitivity analysis performed by excluding trials conducted in the 1980s, the trial with a Jadad score of 1 or the trial that contained neither histopathology of the tumour nor information on the chemotherapy regimen showed a similar effect size to that in the analysis including all studies (data not shown). The histological subgroup analysis revealed no significant heterogeneity within subgroups and among subgroups.…”

“…). Seven were randomized comparisons of neoadjuvant chemotherapy versus surgery alone, 11 were randomized comparisons of neoadjuvant chemoradiotherapy versus surgery alone, and two were randomized comparisons of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy. A three‐arm study that compared neoadjuvant chemoradiotherapy versus adjuvant chemoradiotherapy versus surgery alone was treated as a two‐arm study that compared neoadjuvant chemoradiotherapy versus surgery alone.…”

“…Blinding of patients and clinicians to interventions was not evaluated because it was considered impossible in these kinds of study. Detailed information on drop‐outs was available or there were no drop‐outs in 21 trials. The average Jadad score based on only three evaluation items (randomization, description and adequacy of randomization method, and drop‐outs) was 2·6 of 3, if ‘simple randomization’ was regarded as an inappropriate randomization method.…”

Using the Comprehensive Complication Index to Assess the Impact of Neoadjuvant Chemoradiotherapy on Complication Severity After Esophagectomy for Cancer

“…13 In a study of 40 patients by Bagheri et al, respiratory complications were closely analyzed, and although there was a significant correlation between the number of microorganisms in the sputum and difficulty in weaning, there was no correlation found between neoadjuvant treatment and pulmonary complications. 15 Several meta-analyses showed a decrease in mortality without any proof of a decrease in postoperative complications, but most trials failed to produce information about postoperative complications. 4 , 6 , 9 , 17 Greer et al found no difference in their meta-analysis and concluded that there was a need for large, randomized trials.…”

Society for Translational Medicine Expert Consensus on the prevention and treatment of postoperative pulmonary infection in esophageal cancer patients

“…Perioperative risk factors associated with postoperative pulmonary infection include the existence of pulmonary inflammation and suboptimal control of infection before surgery for patients with chronic bronchitis, chronic cardiac insufficiency, age [≥80 years (5)], a long disease course, obesity (6), smoking (7), excessive drinking, diabetes, malnutrition (7), chronic obstructive pulmonary disease (COPD) (8), preoperative chemotherapy (9), intraoperative use of single lung ventilation, and large intraoperative blood loss (10). In order to reduce postoperative pulmonary complications during esophageal cancer surgery, protective strategies should include an accurate assessment of the patient's preoperative pulmonary function (11); a good understanding of the effect of applying respiratory irritant drugs during anesthesia and the effects of anesthesia on the respiratory tract; attention to reduce physical damage to lung tissue while using doublelumen tracheal intubation; and the application of active measures after surgery, such as, prophylactic antibiotics, pulmonary toilet and nutritional support.…”