title: Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy.
abstract: 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.
authors.affiliation: Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan. skinugasa@yahoo.co.jp
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kinugasa
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Tachibana
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ueda
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Fujii
authors.forename: Dipok Kumar
authors.initials: DK
authors.lastname: Dhar
authors.forename: Takeru
authors.initials: T
authors.lastname: Nakamoto
authors.forename: Naofumi
authors.initials: N
authors.lastname: Nagasue
mesh_terms: 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