Skip to main content
Top
Published in: Surgical Endoscopy 6/2018

01-06-2018

Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer

Authors: Tomoyuki Uchihara, Naoya Yoshida, Yoshifumi Baba, Taisuke Yagi, Tasuku Toihata, Eri Oda, Daisuke Kuroda, Tsugio Eto, Mayuko Ohuchi, Kenichi Nakamura, Hiroshi Sawayama, Koichi Kinoshita, Masaaki Iwatsuki, Takatsugu Ishimoto, Yasuo Sakamoto, Hideo Baba

Published in: Surgical Endoscopy | Issue 6/2018

Login to get access

Abstract

Background

Pulmonary morbidities after esophagectomy are still common and are a major cause of surgery-related mortality. The relationship between minimally invasive esophagectomy (MIE) and pulmonary morbidities is not clear. The current study aimed to examine the incidence of pulmonary morbidities after MIE and to clarify the associated risk factors.

Methods

Between May 2011 and December 2016, 184 patients underwent MIE for esophageal cancer. Clinical data were prospectively collected and analyzed. Patient- and surgery-related factors, relating to pulmonary complications, were compared between the complicated and uncomplicated cases.

Results

The incidence of any pulmonary morbidity following MIE was 17.9%. Univariate analysis showed that past heavy smoking [Brinkman index (BI) ≥ 1000], presence of neoadjuvant therapy, advanced clinical stage (stage III, IV), and intraoperative bleeding ≥ 600 g were candidates for being postoperative pulmonary morbidity risk factors. Multivariate analysis suggested that BI ≥ 1000 and advanced clinical stage were independent risk factors for causing pulmonary morbidities.

Conclusions

Past heavy smoking and advanced stage are independent risk factors for pulmonary morbidities after MIE. When performing MIE for such cases, various preoperative precautions and careful postoperative monitoring are necessary.
Appendix
Available only for authorised users
Literature
2.
go back to reference Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, Kobayashi J, Kuwano H, Motomura N, Nishida H, Saiki Y, Saito A, Shimizu H, Tanaka F, Tanemoto K, Toh Y, Tsukihara H, Wakui S, Yokomise H (2016) Thoracic and cardiovascular surgery in Japan during 2014: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 64(11):665–697. https://doi.org/10.1007/s11748-016-0695-3 CrossRefPubMedPubMedCentral Masuda M, Okumura M, Doki Y, Endo S, Hirata Y, Kobayashi J, Kuwano H, Motomura N, Nishida H, Saiki Y, Saito A, Shimizu H, Tanaka F, Tanemoto K, Toh Y, Tsukihara H, Wakui S, Yokomise H (2016) Thoracic and cardiovascular surgery in Japan during 2014: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 64(11):665–697. https://​doi.​org/​10.​1007/​s11748-016-0695-3 CrossRefPubMedPubMedCentral
5.
go back to reference Kataoka K, Takeuchi H, Mizusawa J, Ando M, Tsubosa Y, Koyanagi K, Daiko H, Matsuda S, Nakamura K, Kato K, Kitagawa Y (2016) A randomized Phase III trial of thoracoscopic versus open esophagectomy for thoracic esophageal cancer: Japan Clinical Oncology Group Study JCOG1409. Jpn J Clin Oncol 46(2):174–177. https://doi.org/10.1093/jjco/hyv178 CrossRefPubMed Kataoka K, Takeuchi H, Mizusawa J, Ando M, Tsubosa Y, Koyanagi K, Daiko H, Matsuda S, Nakamura K, Kato K, Kitagawa Y (2016) A randomized Phase III trial of thoracoscopic versus open esophagectomy for thoracic esophageal cancer: Japan Clinical Oncology Group Study JCOG1409. Jpn J Clin Oncol 46(2):174–177. https://​doi.​org/​10.​1093/​jjco/​hyv178 CrossRefPubMed
6.
go back to reference Mu J, Gao S, Mao Y, Xue Q, Yuan Z, Li N, Su K, Yang K, Lv F, Qiu B, Liu D, Chen K, Li H, Yan T, Han Y, Du M, Xu R, Wen Z, Wang W, Shi M, Xu Q, Xu S, He J (2015) Open three-stage transthoracic oesophagectomy versus minimally invasive thoraco-laparoscopic oesophagectomy for oesophageal cancer: protocol for a multicentre prospective, open and parallel, randomised controlled trial. BMJ Open 5(11):e008328. https://doi.org/10.1136/bmjopen-2015-008328 CrossRefPubMedPubMedCentral Mu J, Gao S, Mao Y, Xue Q, Yuan Z, Li N, Su K, Yang K, Lv F, Qiu B, Liu D, Chen K, Li H, Yan T, Han Y, Du M, Xu R, Wen Z, Wang W, Shi M, Xu Q, Xu S, He J (2015) Open three-stage transthoracic oesophagectomy versus minimally invasive thoraco-laparoscopic oesophagectomy for oesophageal cancer: protocol for a multicentre prospective, open and parallel, randomised controlled trial. BMJ Open 5(11):e008328. https://​doi.​org/​10.​1136/​bmjopen-2015-008328 CrossRefPubMedPubMedCentral
7.
go back to reference Briez N, Piessen G, Bonnetain F, Brigand C, Carrere N, Collet D, Doddoli C, Flamein R, Mabrut JY, Meunier B, Msika S, Perniceni T, Peschaud F, Prudhomme M, Triboulet JP, Mariette C (2011) Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial—the MIRO trial. BMC Cancer 11:310. https://doi.org/10.1186/1471-2407-11-310 CrossRefPubMedPubMedCentral Briez N, Piessen G, Bonnetain F, Brigand C, Carrere N, Collet D, Doddoli C, Flamein R, Mabrut JY, Meunier B, Msika S, Perniceni T, Peschaud F, Prudhomme M, Triboulet JP, Mariette C (2011) Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial—the MIRO trial. BMC Cancer 11:310. https://​doi.​org/​10.​1186/​1471-2407-11-310 CrossRefPubMedPubMedCentral
9.
go back to reference Baba Y, Yoshida N, Shigaki H, Iwatsuki M, Miyamoto Y, Sakamoto Y, Watanabe M, Baba H (2016) Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg Oncol 264(2):305–311. https://doi.org/10.1097/sla.0000000000001510 CrossRef Baba Y, Yoshida N, Shigaki H, Iwatsuki M, Miyamoto Y, Sakamoto Y, Watanabe M, Baba H (2016) Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg Oncol 264(2):305–311. https://​doi.​org/​10.​1097/​sla.​0000000000001510​ CrossRef
10.
go back to reference Saeki H, Tsutsumi S, Tajiri H, Yukaya T, Tsutsumi R, Nishimura S, Nakaji Y, Kudou K, Akiyama S, Kasagi Y, Nakanishi R, Nakashima Y, Sugiyama M, Ohgaki K, Sonoda H, Oki E, Maehara Y (2017) Prognostic significance of postoperative complications after curative resection for patients with esophageal squamous cell carcinoma. Ann Surg 265(3):527–533. https://doi.org/10.1097/sla.0000000000001692 CrossRefPubMed Saeki H, Tsutsumi S, Tajiri H, Yukaya T, Tsutsumi R, Nishimura S, Nakaji Y, Kudou K, Akiyama S, Kasagi Y, Nakanishi R, Nakashima Y, Sugiyama M, Ohgaki K, Sonoda H, Oki E, Maehara Y (2017) Prognostic significance of postoperative complications after curative resection for patients with esophageal squamous cell carcinoma. Ann Surg 265(3):527–533. https://​doi.​org/​10.​1097/​sla.​0000000000001692​ CrossRefPubMed
11.
go back to reference Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York
13.
go back to reference Yoshida N, Watanabe M, Baba Y, Ishimoto T, Iwagami S, Sakamoto Y, Miyamoto Y, Karashima R, Baba H (2014) Influence of preoperative docetaxel, cisplatin, and 5-fluorouracil on the incidence of complications after esophagectomy for resectable advanced esophageal cancer. Dis Esophagus 27(4):374–379. https://doi.org/10.1111/dote.12117 CrossRefPubMed Yoshida N, Watanabe M, Baba Y, Ishimoto T, Iwagami S, Sakamoto Y, Miyamoto Y, Karashima R, Baba H (2014) Influence of preoperative docetaxel, cisplatin, and 5-fluorouracil on the incidence of complications after esophagectomy for resectable advanced esophageal cancer. Dis Esophagus 27(4):374–379. https://​doi.​org/​10.​1111/​dote.​12117 CrossRefPubMed
14.
go back to reference Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, Shimada H, Takiuchi H, Toh Y, Doki Y, Naomoto Y, Matsubara H, Miyazaki T, Muto M, Yanagisawa A (2015) Guidelines for diagnosis and treatment of carcinoma of the esophagus april 2012 edited by the Japan Esophageal Society. Esophagus 12:1–30. https://doi.org/10.1007/s10388-014-0465-1 CrossRefPubMed Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, Shimada H, Takiuchi H, Toh Y, Doki Y, Naomoto Y, Matsubara H, Miyazaki T, Muto M, Yanagisawa A (2015) Guidelines for diagnosis and treatment of carcinoma of the esophagus april 2012 edited by the Japan Esophageal Society. Esophagus 12:1–30. https://​doi.​org/​10.​1007/​s10388-014-0465-1 CrossRefPubMed
15.
go back to reference National Cancer Institute (2010) Common terminology criteria for adverse events (CTCAE). United States Department of Health and Human Services, Bethesda National Cancer Institute (2010) Common terminology criteria for adverse events (CTCAE). United States Department of Health and Human Services, Bethesda
17.
go back to reference Paul DJ, Jamieson GG, Watson DI, Devitt PG, Game PA (2011) Perioperative risk analysis for acute respiratory distress syndrome after elective oesophagectomy. ANZ J Surg 81(10):700–706CrossRefPubMed Paul DJ, Jamieson GG, Watson DI, Devitt PG, Game PA (2011) Perioperative risk analysis for acute respiratory distress syndrome after elective oesophagectomy. ANZ J Surg 81(10):700–706CrossRefPubMed
20.
21.
go back to reference Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379(9829):1887–1892. https://doi.org/10.1016/s0140-6736(12)60516-9 CrossRefPubMed Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379(9829):1887–1892. https://​doi.​org/​10.​1016/​s0140-6736(12)60516-9 CrossRefPubMed
28.
go back to reference Dhungel B, Diggs BS, Hunter JG, Sheppard BC, Vetto JT, Dolan JP (2010) Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005–2008. J Gastrointest Surg 14(10):1492–1501. https://doi.org/10.1007/s11605-010-1328-2 CrossRefPubMed Dhungel B, Diggs BS, Hunter JG, Sheppard BC, Vetto JT, Dolan JP (2010) Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005–2008. J Gastrointest Surg 14(10):1492–1501. https://​doi.​org/​10.​1007/​s11605-010-1328-2 CrossRefPubMed
29.
go back to reference Yoshida N, Baba Y, Hiyoshi Y, Shigaki H, Kurashige J, Sakamoto Y, Miyamoto Y, Iwatsuki M, Ishimoto T, Kosumi K, Sugihara H, Harada K, Tokunaga R, Izumi D, Watanabe M, Baba H (2016) Duration of smoking cessation and postoperative morbidity after esophagectomy for esophageal cancer: how long should patients stop smoking before surgery? World J Surg 40(1):142–147. https://doi.org/10.1007/s00268-015-3236-9 CrossRefPubMed Yoshida N, Baba Y, Hiyoshi Y, Shigaki H, Kurashige J, Sakamoto Y, Miyamoto Y, Iwatsuki M, Ishimoto T, Kosumi K, Sugihara H, Harada K, Tokunaga R, Izumi D, Watanabe M, Baba H (2016) Duration of smoking cessation and postoperative morbidity after esophagectomy for esophageal cancer: how long should patients stop smoking before surgery? World J Surg 40(1):142–147. https://​doi.​org/​10.​1007/​s00268-015-3236-9 CrossRefPubMed
30.
go back to reference Yoshida N, Baba Y, Shigaki H, Harada K, Iwatsuki M, Kurashige J, Sakamoto Y, Miyamoto Y, Ishimoto T, Kosumi K, Tokunaga R, Imamura Y, Ida S, Hiyoshi Y, Watanabe M, Baba H (2016) Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg 40(8):1910–1917. https://doi.org/10.1007/s00268-016-3549-3 CrossRefPubMed Yoshida N, Baba Y, Shigaki H, Harada K, Iwatsuki M, Kurashige J, Sakamoto Y, Miyamoto Y, Ishimoto T, Kosumi K, Tokunaga R, Imamura Y, Ida S, Hiyoshi Y, Watanabe M, Baba H (2016) Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg 40(8):1910–1917. https://​doi.​org/​10.​1007/​s00268-016-3549-3 CrossRefPubMed
33.
go back to reference Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K (2002) Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol 28(4):396–400CrossRefPubMed Nozoe T, Kimura Y, Ishida M, Saeki H, Korenaga D, Sugimachi K (2002) Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma. Eur J Surg Oncol 28(4):396–400CrossRefPubMed
34.
go back to reference Nakamura M, Iwahashi M, Nakamori M, Ishida K, Naka T, Iida T, Katsuda M, Tsuji T, Nakatani Y, Yamaue H (2008) An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbeck’s Arch Surg 393(2):127–133. https://doi.org/10.1007/s00423-007-0253-7 CrossRef Nakamura M, Iwahashi M, Nakamori M, Ishida K, Naka T, Iida T, Katsuda M, Tsuji T, Nakatani Y, Yamaue H (2008) An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbeck’s Arch Surg 393(2):127–133. https://​doi.​org/​10.​1007/​s00423-007-0253-7 CrossRef
37.
go back to reference Yamana I, Takeno S, Hashimoto T, Maki K, Shibata R, Shiwaku H, Shimaoka H, Shiota E, Yamashita Y (2015) Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig Surg 32(5):331–337. https://doi.org/10.1159/000434758 CrossRefPubMed Yamana I, Takeno S, Hashimoto T, Maki K, Shibata R, Shiwaku H, Shimaoka H, Shiota E, Yamashita Y (2015) Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig Surg 32(5):331–337. https://​doi.​org/​10.​1159/​000434758 CrossRefPubMed
42.
go back to reference Kawahara Y, Ninomiya I, Fujimura T, Funaki H, Nakagawara H, Takamura H, Oyama K, Tajima H, Fushida S, Inaba H, Kayahara M (2010) Prospective randomized controlled study on the effects of perioperative administration of a neutrophil elastase inhibitor to patients undergoing video-assisted thoracoscopic surgery for thoracic esophageal cancer. Dis Esophagus 23(4):329–339. https://doi.org/10.1111/j.1442-2050.2009.01010.x CrossRefPubMed Kawahara Y, Ninomiya I, Fujimura T, Funaki H, Nakagawara H, Takamura H, Oyama K, Tajima H, Fushida S, Inaba H, Kayahara M (2010) Prospective randomized controlled study on the effects of perioperative administration of a neutrophil elastase inhibitor to patients undergoing video-assisted thoracoscopic surgery for thoracic esophageal cancer. Dis Esophagus 23(4):329–339. https://​doi.​org/​10.​1111/​j.​1442-2050.​2009.​01010.​x CrossRefPubMed
Metadata
Title
Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer
Authors
Tomoyuki Uchihara
Naoya Yoshida
Yoshifumi Baba
Taisuke Yagi
Tasuku Toihata
Eri Oda
Daisuke Kuroda
Tsugio Eto
Mayuko Ohuchi
Kenichi Nakamura
Hiroshi Sawayama
Koichi Kinoshita
Masaaki Iwatsuki
Takatsugu Ishimoto
Yasuo Sakamoto
Hideo Baba
Publication date
01-06-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5993-z

Other articles of this Issue 6/2018

Surgical Endoscopy 6/2018 Go to the issue