Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy.
BACKGROUND
Risk analysis of pulmonary complications after extended esophagectomy with three-field lymph node dissection (3FLND) has been little reported in the literature.


METHODS
Risk factors of developing postoperative pneumonia after extended esophagectomy and its effects on in-hospital death and overall long-term survival were compared between 38 patients who developed pneumonia and 80 patients who did not.


RESULTS
Eight patients died of postoperative complications during the hospital stay after esophagectomy. Seven of those 8 patients developed pneumonia, whereas 31 patients of 110 patients who were discharged from the hospital developed pneumonia (P < 0.01). Pneumonia occurred more frequently in elderly patients (P < 0.01), in heavy smokers (P < 0.05), in patients with preoperative pulmonary obstructive dysfunction (P < 0.05), and in patients who received 3 U or more perioperative blood transfusion (P < 0.05). Five-year overall survival rate (26.7%) of 38 patients who developed pneumonia was significantly worse than 53.4% who did not develop pneumonia (P < 0.01). Multivariate analysis of prognostic factors for overall survival showed that pathological tumor stage (hazard ratio 5.380, P < 0.01) and pneumonia (hazard ratio 2.369, P < 0.01) were independent risk factors. Postoperative pneumonia is correlated with in-hospital death and poorer long-term survival after extended esophagectomy with 3FLND.


CONCLUSIONS
Elderly patients with a history of heavy smoking and poor pulmonary function should be regarded as a high-risk group of patients for developing pneumonia and very careful selection is required before subjecting such patients to extended esophagectomy.
Kinugasa
Shoichi
S
Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan. skinugasa@yahoo.co.jp
Tachibana
Mitsuo
M
Yoshimura
Hiroshi
H
Ueda
Shuhei
S
Fujii
Toshiyuki
T
Dhar
Dipok Kumar
DK
Nakamoto
Takeru
T
Nagasue
Naofumi
N
D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D017741:Survivors; D016896:Treatment Outcome