title: An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer.
abstract: BACKGROUND
  Pulmonary complications occur most frequently following a transthoracic esophagectomy for esophageal cancer and would get to be lethal occasionally. In this study, we sought to determine the effect of respiratory physiotherapy, corticosteroid administration, and the use of the video-assisted thoracoscopic (VATS) esophagectomy with a small thoracotomy incision, on the incidence of pulmonary complications following a transthoracic subtotal esophagectomy.
  
  
  METHODS
  Approximately 184 patients who had undergone a right transthoracic subtotal esophagectomy for squamous cell carcinoma of the thoracic esophagus were studied. To reduce the incidence of pulmonary complications, we performed clinical trials using respiratory physiotherapy, corticosteroid administration, and the VATS-esophagectomy surgical technique.
  
  
  RESULTS
  The independent risk factors for pulmonary complications in the multivariate logistic regression analysis were not administering corticosteroids, blood loss greater than 630 ml, and not providing respiratory physiotherapy. In addition, the use of a small surgical incision, less than 10 cm, for the thoracotomy had no effect on the prevention of pulmonary complications.
  
  
  CONCLUSIONS
  We concluded that patients with thoracic esophageal cancer could undergo a three-field dissection in comparative safety if the patients were provided with corticosteroid medication in the perioperative period, if the patients received sufficient respiratory physiotherapy, and if surgical blood loss was reduced.
authors: Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors: Masaki
authors: M
authors: Nakamura
authors: Makoto
authors: M
authors: Iwahashi
authors: Mikihito
authors: M
authors: Nakamori
authors: Koichiro
authors: K
authors: Ishida
authors: Teiji
authors: T
authors: Naka
authors: Takeshi
authors: T
authors: Iida
authors: Masahiro
authors: M
authors: Katsuda
authors: Toshiaki
authors: T
authors: Tsuji
authors: Yoshihiro
authors: Y
authors: Nakatani
authors: Hiroki
authors: H
authors: Yamaue
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000428:Alcohol Drinking / Q000517:prevention & control; D001945:Breathing Exercises; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care; D001261:Pulmonary Atelectasis / Q000453:epidemiology / Q000517:prevention & control*; D012143:Respiratory Physiological Phenomena; D012307:Risk Factors; D016540:Smoking Cessation; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy
chemical_list: D000305:Adrenal Cortex Hormones