title: Preoperative airway colonization prior to transthoracic esophagectomy predicts postoperative pulmonary complications.
abstract: OBJECTIVE
  Respiratory complications are responsible to a high degree for postoperative morbidity and mortality after Ivor-Lewis esophagectomy. The etiology of respiratory failure is known to be multifactorial with preoperative impaired lung function being the most important one. The aim of this study was to investigate the correlation between preoperative airway colonization (PAC) and postoperative respiratory complications.
  
  
  METHODS
  In this observational study, 64 patients with esophageal cancer were included. All patients underwent Ivor-Lewis esophagectomy with laparoscopic or open gastric mobilization. After induction of anesthesia and intubation with a double-lumen tube, bronchial exudate was collected by random endoluminal suction for further microbiological work-up. Length of postoperative mechanical ventilation (<24 h, 24-72 h, >72 h), re-intubation, and tracheostomy were recorded as primary and secondary study endpoints.
  
  
  RESULTS
  In 13 of 64 study patients (20.3 %), pathological colonization of the bronchial airways could be proved prior to esophagectomy. Haemophilus species was the most frequently identified pathogen. PAC was associated with a longer history of smoking (p = 0.025), a lower preoperative forced expiratory volume (FEV1, p = 0.009) or vital capacity (VC, p = 0.038), a prolonged postoperative mechanical ventilation (p < 0.001), and a higher frequency of re-intubation (p < 0.001) and tracheostomy (p = 0.017). In the multivariate analysis, PAC was identified as an independent predictor of respiratory failure (hazard ratio 11.4, 95 % confidence interval 2.6-54, p = 0.002). Mortality in the PAC group was 30.8 % compared to 0 % in patients without PAC (p < 0.0001).
  
  
  CONCLUSIONS
  PAC is a significant risk factor for postoperative respiratory failure. A routine bronchoscopy and bronchoalveolar lavage as part of preoperative management prior to esophagectomy need to be discussed.
authors.affiliation: Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bludau
authors.forename: A H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: E
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: J M
authors.initials: JM
authors.lastname: Leers
authors.forename: C A
authors.initials: CA
authors.lastname: Gutschow
authors.forename: S
authors.initials: S
authors.lastname: Brinkmann
authors.forename: W
authors.initials: W
authors.lastname: Schröder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000382:microbiology*; D002277:Carcinoma / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology*; D016896:Treatment Outcome