title: Community-acquired pneumonia during long-term follow-up of patients after radical esophagectomy for esophageal cancer: analysis of incidence and associated risk factors.
abstract: BACKGROUND
  There are no data concerning the occurrence of community-acquired pneumonia (CAP) in esophageal cancer patients during long-term follow-up after radical esophagectomy. The aims of the present study were to determine the incidence of CAP in esophageal cancer patients who underwent radical esophagectomy and to identify the risk factors.
  
  
  METHODS
  A total of 186 consecutive patients who underwent radical esophagectomy for thoracic esophageal carcinoma in our hospital between 1991 and 2000 were enrolled in this study. Data on the occurrence of CAP were retrospectively collected from medical records, follow-up files, and telephone interviews with patients. The cumulative incidence of CAP was calculated by the Kaplan-Meier method, and the risk factors for CAP were determined by univariate and multivariate analyses. The median follow-up time was 77 months (range 12-216 months).
  
  
  RESULTS
  Sixty patients suffered from CAP during the follow-up period. The cumulative incidence was 25.8% at 5 years and 38.4% at 10 years. Multivariate analysis revealed the following as the significant risk factors for CAP: presence of lymph node metastasis (Hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.55-4.50; P < 0.001), colonic interposition (HR, 2.87; 95% CI, 1.41-5.82; P = 0.004), obstructive lung disease (HR, 1.95; 95% CI, 1.11-3.42; P = 0.021), and preoperative hypoalbuminemia (HR, 2.08; 95% CI, 1.20-3.60; P = 0.009).
  
  
  CONCLUSIONS
  There is a high incidence of CAP in esophageal cancer patients after esophagectomy. Positive nodal metastasis, colonic interposition, obstructive lung disease, and preoperative hypoalbuminemia are risk factors for this long-term postoperative morbidity.
authors: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori 1-757, Niigata, 951-8510, Japan.
authors: Takaaki
authors: T
authors: Hanyu
authors: Tatsuo
authors: T
authors: Kanda
authors: Kazuhito
authors: K
authors: Yajima
authors: Yoshinari
authors: Y
authors: Tanabe
authors: Shintaro
authors: S
authors: Komukai
authors: Shin-Ichi
authors: S
authors: Kosugi
authors: Tsutomu
authors: T
authors: Suzuki
authors: Katsuyoshi
authors: K
authors: Hatakeyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors