title: Time-trend analysis of the pulmonary function after surgical treatment for esophageal cancer.
abstract: OBJECTIVE
  To evaluate, in function of time, the modification of pulmonary function after radical esophagectomy with the aim of identifying clinical and/or surgical predictors of functional worsening.
  
  
  METHODS
  Data of 57 patients operated from 01/06 to 06/11 were retrospectively reviewed. Thirty-eight patients (67%) underwent transhiatal cervico-laparotomic (CL-Group) and 19 (33%) a Mc-Keown cervico-thoraco-laparotomic esophagectomy (CTL-Group). The pulmonary function has been evaluated before and one month after surgery. The outcome has been benchmarked with demographic/clinical characteristics, the type of operation and the presence of post-operative pulmonary complications (POPCs).
  
  
  RESULTS
  Mean age and male/female distribution were 66.6±10.6 yrs and 39/18, respectively. A total of 14 (24% of total sample) POPCs occurred with a significantly higher occurrence in the CTL-Group (71% vs 28%, p < 0.001) and in those patients with a pre-operative concurrent pathological condition (64% in COPD patients vs 36% in patients without COPD, p = 0.021). A global worsening of the spirometric parameters (expressed as the baseline percentage change, Δ) emerged, but this decrease was significantly higher in the CTL-Group in terms of Δ-FVC (p = 0.005) and Δ-FEV1 (p = 0.005). Similarly, those patients who have experienced a POPC, showed a higher reduction of the pulmonary function regardless of the surgical approach when compared with those who did not (Δ-FVC: p = 0.053 and Δ-FEV1%: p = 0.015).
  
  
  CONCLUSIONS
  In the context of a global reduction of pulmonary function, patients who underwent trans-thoracic esophagectomy or experienced a POPC showed a significantly worse pattern. These patients could be the "best target" for therapeutic rehabilitative strategies in the pre-operative and/or post-operative setting. This assumption is to be proven through prospective clinical trials.
authors.affiliation: Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. zjdocchina@163.com.
authors.forename: F
authors.initials: F
authors.lastname: Lococo
authors.forename: A
authors.initials: A
authors.lastname: Cesario
authors.forename: S
authors.initials: S
authors.lastname: Margaritora
authors.forename: G
authors.initials: G
authors.lastname: Apolone
authors.forename: S
authors.initials: S
authors.lastname: Cavuto
authors.forename: G
authors.initials: G
authors.lastname: Leuzzi
authors.forename: F
authors.initials: F
authors.lastname: Pasqua
authors.forename: V
authors.initials: V
authors.lastname: Cardaci
authors.forename: L
authors.initials: L
authors.lastname: Petracca Ciavarella
authors.forename: P
authors.initials: P
authors.lastname: Granone
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies