title: An early inflammatory response to oesophagectomy predicts the occurrence of pulmonary complications.
abstract: BACKGROUND
  Respiratory complications are the most frequent concern following oesophagectomy. We aimed to assess the postoperative inflammatory response after oesophagectomy and to determine its reliability to predict the occurrence of pulmonary complications.
  
  
  METHODS
  A total of 97 patients were enrolled in this prospective observational study. All patients underwent a transthoracic oesophagectomy for cancer. From D0 to D3, plasmatic cytokine levels (interleukin (IL)-1, IL-6, IL-8, IL-10, tumour necrosis factor (TNF)-alpha), short synacthen test (SST), PaO(2)/FiO(2) ratio and clinical factors determining the systemic inflammatory response syndrome (SIRS) were monitored and compared between patients who experienced pulmonary complications (group I) and those who did not (group II).
  
  
  RESULTS
  The overall in-hospital mortality was 5%. Postoperative pulmonary complications occurred in 33 patients (34%). Sputum retention was the first step of pulmonary complications in 26 patients (occurring at a mean of 2.8+/-1 days after the operation), leading to pneumonia in 22 patients (4.7+/-1 days) and acute respiratory distress syndrome (ARDS) in 10 (6.9+/-3 days). At day 2, group I patients had significantly higher plasmatic levels of IL-6, IL-10 and TNF-alpha than group II patients. PaO(2)/FiO(2) was impaired accordingly (215 vs 348; p=0.006). SST was negative in 38% of group I patients and in 30% of group II patients (p=0.51). SIRS was present in 33% and 6% of group I and group II patients, respectively (p< or =0.01). At multivariate analysis, early occurrence of SIRS was the sole significant predictor of pulmonary complications (p=0.005; odds ratio (OR):11.4, confidence interval (CI): 2-63).
  
  
  CONCLUSIONS
  The vast majority of postoperative pulmonary complications after oesophagectomy occur after the 4th postoperative day. The earlier detection (first 48 h) of SIRS, high plasmatic cytokine levels and impairment of PaO(2)/FiO(2) predicts the onset of these complications. This finding suggests that early pharmacological intervention may have a beneficial impact.
authors.affiliation: Department of Thoracic Surgery, University of the Mediterranean & Assistance Publique-Hôpitaux de Marseille, Sainte Marguerite Hospital, Marseille, France. xavier.djourno@ap-hm.fr
authors.forename: Xavier Benoit
authors.initials: XB
authors.lastname: D'Journo
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Valérie
authors.initials: V
authors.lastname: Marin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Diesnis
authors.forename: Dorothée
authors.initials: D
authors.lastname: Blayac
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Pierre
authors.initials: P
authors.lastname: Bongrand
authors.forename: Pascal Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D016207:Cytokines / Q000097:blood; D004812:Epidemiologic Methods; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011014:Pneumonia / Q000209:etiology*; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D010100:Oxygen