title: Impact of the surgical technique on pulmonary morbidity after esophagectomy.
abstract: BACKGROUND
  Pulmonary complications occur frequently after esophagectomy. Although multifactorial, these complications could be influenced by surgical technique. We sought to compare the respiratory complications of patients undergoing esophagectomy through different approaches, and identify technical risk factors.
  
  
  METHODS
  We conducted a retrospective analysis of consecutive esophagectomies performed at 2 institutions from January 2002 to January 2009. Primary outcome measures included postoperative ventilatory requirements, pneumonia, effusion requiring intervention, length of stay, and mortality.
  
  
  RESULTS
  A total of 220 esophagectomies were performed through 6 different approaches: 79 minimally invasive (MIE) with neck anastomosis, 20 MIE with chest anastomosis, 37 transhiatal, 33 McKeown, 36 Ivor Lewis, and 15 left thoracoabdominal. Patients who underwent MIE were more likely to be extubated in the operating room (p<0.01) and had fewer pleural effusions (p<0.01). A thoracotomy was associated with a higher incidence of tracheostomy (p=0.02) and pleural effusions (p=0.02). Neck anastomoses were negatively associated with early extubation (p=0.04) and predicted recurrent laryngeal nerve injury (p=0.04), but were not associated with pneumonia or other pulmonary complications. Multivariate analysis showed that pneumonia was independently associated with advancing age (p=0.02), lack of a pyloric drainage procedure (p=0.03), and less significantly with MIE (p=0.06, fewer events). Surgical approach was not a significant predictor of length of stay or mortality.
  
  
  CONCLUSIONS
  Patients undergoing MIE are less likely to remain intubated. Omission of a pyloric drainage procedure or performance of thoracic or neck incisions appear to be important determinants of respiratory complications. Technical aspects of the procedure in addition to the surgical approach influence important respiratory outcomes.
authors: Division of Thoracic Surgery, Albany Medical Center, Department of Surgery, Albany Medical College, Albany, New York 12208, USA. bakhosc@mail.amc.edu
authors: Charles T
authors: CT
authors: Bakhos
authors: Thomas
authors: T
authors: Fabian
authors: Tolutope O
authors: TO
authors: Oyasiji
authors: Shiva
authors: S
authors: Gautam
authors: Sidhu P
authors: SP
authors: Gangadharan
authors: Michael S
authors: MS
authors: Kent
authors: Jeremiah
authors: J
authors: Martin
authors: Jonathan F
authors: JF
authors: Critchlow
authors: Malcolm M
authors: MM
authors: DeCamp
mesh_terms: D003237:Connecticut / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008171:Lung Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends