Airflow Limitation Predicts Postoperative Pneumonia after Esophagectomy
Suguru Maruyama
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorCorresponding Author
Akihiko Okamura
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
[email protected]Search for more papers by this authorNaoki Ishizuka
Department of Clinical Trial Planning and Management, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorYasukazu Kanie
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorKei Sakamoto
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorDaisuke Fujiwara
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorJun Kanamori
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorYu Imamura
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorMasayuki Watanabe
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorSuguru Maruyama
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorCorresponding Author
Akihiko Okamura
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
[email protected]Search for more papers by this authorNaoki Ishizuka
Department of Clinical Trial Planning and Management, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorYasukazu Kanie
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorKei Sakamoto
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorDaisuke Fujiwara
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorJun Kanamori
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorYu Imamura
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorMasayuki Watanabe
Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, 135-8550 Tokyo, Japan
Search for more papers by this authorSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00268-021-06148-7.
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is known to be a risk factor of pneumonia after esophagectomy. In this study, we investigated the relationship of airflow limitation with the occurrence and the severity of pneumonia in esophageal cancer patients who underwent esophagectomy.
Methods
We enrolled 844 patients who underwent curative esophagectomy between 2009 and 2018. The airflow limitation was evaluated using the percent-predicted forced expiratory volume at 1 s (%FEV1) with spirometry.
Results
There were 597 (70.7%), 141 (16.7%), 68 (8.1%), and 38 patients (4.5%) with %FEV1 of ≥ 90%, 80–90%, 70–80%, and < 70% categories, respectively. One hundred and ninety-one patients (22.6%) occurred pneumonia, and the incidences of pneumonia in each category of patients were 18.8%, 28.4%, 29.4%, and 50.0%, respectively. In multivariate analysis, the categories of 80%–90%, 70–80%, and < 70% were significantly associated with a higher incidence of postoperative pneumonia (OR 1.57; 95% CI 1.02–2.43, OR 1.87; 95% CI 1.04–3.36, OR 3.34; 95% CI 1.66–6.71, respectively), with the %FEV1 category of ≥ 90% as reference. The incidence of severe pneumonia of Clavien–Dindo grade III or higher was also significantly associated with the %FEV1. In patients without COPD, the incidence of pneumonia was significantly higher in those with %FEV1 < 90% than in those with %FEV1 ≥ 90% (32.2% versus 17.5%, p < 0.001).
Conclusions
The airflow limitation can help predict the occurrence of pneumonia after esophagectomy in patients with and without COPD. Exclusive preventive measures should be considered in patients with reduced %FEV1 undergoing esophagectomy.
Supporting Information
| Filename | Description |
|---|---|
| wjsbf01137-sup-0001.docxapplication/docx, 31.1 KB | Supplementary file1 (DOCX 31 kb) |
| wjsbf01137-sup-0002.tifapplication/tif, 2 MB | Supplementary file2 (TIF 2025 kb) |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Bray F, Ferlay J, Soerjomataram I et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin (2018) 68: 394–42410.3322/caac.21492
- 2Takeuchi H, Miyata H, Gotoh M et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg (2014) 260: 259–26610.1097/SLA.0000000000000644
- 3Osugi H, Takemura M, Higashino M et al. A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg (2003) 90: 108–11310.1002/bjs.4022
- 4Kitagawa H, Namikawa T, Munekage M et al. Outcomes of thoracoscopic esophagectomy in prone position with laparoscopic gastric mobilization for esophageal cancer. Langenbecks Arch Surg (2016) 401: 699–70510.1007/s00423-016-1446-8
- 5Atkins BZ, D'Amico TA Respiratory complications after esophagectomy. Thorac Surg Clin (2006) 16(35–48): vi
- 6Nakagawa A, Nakamura T, Oshikiri T et al. The surgical apgar score predicts not only short-term complications but also long-term prognosis after esophagectomy. Ann Surg Oncol (2017) 24: 3934–394610.1245/s10434-017-6103-0
- 7Baba Y, Yoshida N, Shigaki H et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg (2016) 264: 305–31110.1097/SLA.0000000000001510
- 8Ferguson MK, Celauro AD, Prachand V (2011) Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg 91: 1494–1500; discussion 1500-1491
- 9Okamura A, Watanabe M, Mine S et al. spirometric lung age predicts postoperative pneumonia after esophagectomy. World J Surg (2016) 40: 2412–241810.1007/s00268-016-3547-5
- 10Mathers CD, Loncar D Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med (2006) 3: e44210.1371/journal.pmed.0030442
- 11Singh D, Agusti A, Anzueto A et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J (2019) 53: 190016410.1183/13993003.00164-2019
- 12Brierley JDGM, (eds) WC (2017) TNM classification of malignant tumors. Oxford 8
- 13M S, Grading of patients for surgical procedures. Anesthesiol (1941) 5: 281–284
- 14Kubota M, Kobayashi H, Quanjer PH et al. Reference values for spirometry, including vital capacity, in Japanese adults calculated with the LMS method and compared with previous values. Respir Investig (2014) 52: 242–25010.1016/j.resinv.2014.03.003
- 15Kitagawa Y, Uno T, Oyama T et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1. Esophagus (2019) 16: 1–2410.1007/s10388-018-0641-9
- 16Kitagawa Y, Uno T, Oyama T et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 2. Esophagus (2019) 16: 25–4310.1007/s10388-018-0642-8
- 17Ando N, Kato H, Igaki H et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol (2012) 19: 68–7410.1245/s10434-011-2049-9
- 18Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg (2009) 250: 187–19610.1097/SLA.0b013e3181b13ca2
- 19Katayama H, Kurokawa Y, Nakamura K et al. Extended clavien-dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today (2016) 46: 668–68510.1007/s00595-015-1236-x
- 20Kanda Y Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant (2013) 48: 452–45810.1038/bmt.2012.244
- 21Fang W, Kato H, Tachimori Y et al. Analysis of pulmonary complications after three-field lymph node dissection for esophageal cancer. Ann Thorac Surg (2003) 76: 903–90810.1016/S0003-4975(03)00549-6
- 22Law S, Wong KH, Kwok KF et al. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg (2004) 240: 791–80010.1097/01.sla.0000143123.24556.1c
- 23Nakamura M, Iwahashi M, Nakamori M et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg (2008) 393: 127–13310.1007/s00423-007-0253-7
- 24Dhungel B, Diggs BS, Hunter JG et al. Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American college of surgeons national surgical quality improvement program (ACS-NSQIP), 2005–2008. J Gastrointest Surg (2010) 14: 1492–150110.1007/s11605-010-1328-2
- 25Zingg U, Smithers BM, Gotley DC et al. Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol (2011) 18: 1460–146810.1245/s10434-010-1474-5
- 26Bakhos CT, Fabian T, Oyasiji TO, et al (2012) Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg 93: 221–226; discussion 226-227
- 27Shiozaki A, Fujiwara H, Okamura H et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett (2012) 3: 907–912227410163362471
- 28Yoshida N, Watanabe M, Baba Y et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today (2014) 44: 526–53210.1007/s00595-013-0577-6
- 29Oshikiri T, Takiguchi G, Hasegawa H et al. Postoperative recurrent laryngeal nerve palsy is associated with pneumonia in minimally invasive esophagectomy for esophageal cancer. Surg Endosc (2020) 35(2): 837–84410.1007/s00464-020-07455-1
- 30Hayashi M, Takeuchi H, Nakamura R et al. Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy. Esophagus (2020) 17: 50–5810.1007/s10388-019-00692-x
- 31Ozawa S, Koyanagi K, Ninomiya Y et al. Postoperative complications of minimally invasive esophagectomy for esophageal cancer. Ann Gastroenterol Surg (2020) 4: 126–13410.1002/ags3.12315
- 32Valkenet K, Trappenburg JCA, Ruurda JP et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg (2018) 105: 502–51110.1002/bjs.10803
- 33Yamana I, Takeno S, Hashimoto T et al. Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig Surg (2015) 32: 331–33710.1159/000434758
- 34Dettling DS, van der Schaaf M, Blom RL et al. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. Physiother Res Int (2013) 18: 16–2610.1002/pri.1524
- 35Agrelli TF, de Carvalho RM, Guglielminetti R et al. Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study Int Surg (2012) 97: 198–20223113846
- 36Hulzebos EH, Helders PJ, Favié NJ et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA (2006) 296: 1851–185710.1001/jama.296.15.1851
- 37Akutsu Y, Matsubara H, Okazumi S et al. Impact of preoperative dental plaque culture for predicting postoperative pneumonia in esophageal cancer patients. Dig Surg (2008) 25: 93–9710.1159/000121903
- 38Yuda M, Yamashita K, Okamura A et al. Influence of preoperative oropharyngeal microflora on the occurrence of postoperative pneumonia and survival in patients undergoing esophagectomy for esophageal cancer. Ann Surg (2020) 272: 1035–104310.1097/SLA.0000000000003287
- 39Akutsu Y, Matsubara H, Shuto K et al. Pre-operative dental brushing can reduce the risk of postoperative pneumonia in esophageal cancer patients. Surgery (2010) 147: 497–50210.1016/j.surg.2009.10.048
- 40Soutome S, Yanamoto S, Funahara M et al. Preventive effect on post-operative pneumonia of oral health care among patients who undergo esophageal resection: a multi-center retrospective study. Surg Infect (Larchmt) (2016) 17: 479–48410.1089/sur.2015.158
- 41Kobayashi S, Suzuki S, Niikawa H et al. Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD. Respirology (2009) 14: 675–67910.1111/j.1440-1843.2009.01543.x
- 42Nojiri T, Inoue M, Yamamoto K et al. Inhaled tiotropium to prevent postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery. Surg Today (2014) 44: 285–29010.1007/s00595-012-0481-5
- 43Okamura A, Watanabe M, Kitazono S, et al (2020) The Design of and Rationale for the Effect of Perioperative Inhaled Tiotropium for Patients with Chronic Obstructive Pulmonary Disease in Esophageal Cancer Surgery (EPITOPE): an Open-Label, Randomized, Parallel-Group Study. Eur Surg Res: 1–7
- 44Sentürk M, Ozcan PE, Talu GK, et al (2002) The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg 94: 11–15, table of contents
