Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 2/2019

01-02-2019 | Original Article

Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer

Authors: Masaki Ohi, Yuji Toiyama, Yusuke Omura, Takashi Ichikawa, Hiromi Yasuda, Yoshinaga Okugawa, Hiroyuki Fujikawa, Yoshiki Okita, Shigeyuki Yoshiyama, Junichiro Hiro, Toshimitsu Araki, Masato Kusunoki

Published in: Surgery Today | Issue 2/2019

Login to get access

Abstract

Purpose

Postoperative pulmonary complications (PCs) after thoracoscopic esophagectomy for esophageal cancer (EC) still occur too frequently. We conducted this study to identify the risk factors for PCs developing in EC patients who undergo thoracoscopic esophagectomy.

Methods

The subjects of this retrospective study were 89 patients with EC who underwent thoracoscopic esophagectomy in our department between January 2010 and December 2015. Univariate and multivariate logistic regression analyses were used to evaluate the association between the incidence of PC and clinical factors. In January 2016, we introduced a new prophylactic intervention for reducing the incidence of delirium and assessed its significance for PCs.

Results

PCs developed in 19 patients (21.3%). Univariate analysis revealed the following risk factors: age (> 69 years), ratio of the forced expiratory volume in 1 s to forced vital capacity (< 70%), chronic obstructive pulmonary disease (COPD), and postoperative delirium. Multivariate analysis found that COPD and postoperative delirium were independent risk factors for PCs. Our new intervention for delirium significantly reduced its occurrence (p = 0.00004) and also the frequency of PCs (p = 0.04148).

Conclusions

Postoperative delirium and COPD were risk factors for PCs in patients who underwent thoracoscopic esophagectomy. Our intervention study showed clearly that reducing the occurrence of postoperative delirium could decrease the incidence of PCs.
Literature
1.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.CrossRef
2.
Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc. 2010;24(7):1621–9.CrossRef
3.
Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001;233:338–44.CrossRef
4.
Nagawa H, Kobori O, Muto T. Prediction of pulmonary complications after transthoracic oesophagectomy. Br J Surg. 1994;81:860–2.CrossRef
5.
Avendano CE, Flume PA, Silvestri GA, King LB, Reed CE. Pulmonary complications after esophagectomy. Ann Thoacic Surg. 2002;73:922–6.CrossRef
6.
Ferguson MK, Dulkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002;123:661–9.CrossRef
7.
Rutegard M, Lagergren P, Rouvelas I, Mason R, Lagergren J. Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study. Eur J Surg Oncol. 2012;38(7):555–61.CrossRef
8.
Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004;88:71–7.CrossRef
9.
Kataoka K, Takeurgchi H, Mizusawa J, Igaki H, Ozawa S, Abe T, et al. Prognosis impact of postoperative morbidity after esophagectomy for esophageal cancer. Exploratory analysis of LCOG 9907. Ann Surg. 2017;265:1152–7.CrossRef
10.
Watson DI, Jamieson GG, Devitt PG. Endoscopic cervico-thoraco-abdominal esophagectomy. J Am Coll Surg. 2000;190:372–8.CrossRef
11.
Palanivelu C, Prakash A, Senthikumar R, Senthilnathan P, Parthasarathi R, Rajan PS, et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position experience of 130 patients. J Am Coll Surg. 2006;203:7–16.CrossRef
12.
Koide N, Takeuchi D, Suzuki A, Miyagawa S. Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities. Surg Today. 2012;42:127–34.CrossRef
13.
Osugi H, Takemura M, Higashino M, Takada N, Lee S, Kinoshita H. A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg. 2003;90:108–13.CrossRef
14.
Takeuchi H, Miyata H, Gotoh M, Kitagawa Y, Baba H, Kimura W, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260(2):259–66.CrossRef
15.
Bakhos CT, Fabian T, Oyasiji TO, Gautam S, Gangadharan SP, Kent MS, et al. Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg. 2012;93:221–6.CrossRef
16.
Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg. 2011;91:1494–500.CrossRef
17.
Nakamura M, Iwahashi M, Nakamori M, Ishida K, Naka T, Iida T, et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2008;393:127–33.CrossRef
18.
Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulumonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240:791–800.CrossRef
19.
Dhungel B, Diggs BS, Hunter JG, Sheppard BC, Vetto JT, Dolan JP. 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. 2010;14:1492–501.CrossRef
20.
Fang W, Kato H, Tachimori Y, Igaki H, Sato H, Daiko H. Analysis of pulmonary complications after three-field lymph node dissection for esophageal cancer. Ann Thorac Surg. 2003;76:903–8.CrossRef
21.
Yoshida N, Watanabe M, Baba Y, Iwagami S, Ishimoto T, Iwatsuki M, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44:526–32.CrossRef
22.
Japan Esophageal Society. Japanese classification of esophageal cancer, tenth edition: part I. Esophagus. 2009;6:1–25.CrossRef
23.
Toiyama Y, Miki C, Inoue Y, Tanaka K, Mohri Y, Kusunoki M. Evaluation of an inflammation-based prognostic score for the identification of patients requiring postoperative adjuvant chemotherapy for stage II colorectal cancer. Exp Ther Med. 2011;2(1):95–101.CrossRef
24.
25.
Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19(1):68–74.CrossRef
26.
Shiozaki A, Fujiwara H, Okamura H, Murayama Y, Komatsu S, Kuriu Y, et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett. 2012;3(4):907–12.PubMedPubMedCentral
27.
Dind D, Demartines N, Clavien PS. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a surgery. Ann Surg. 2004;240:205–13.CrossRef
28.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition, JAMA. 2012;307:2526–33.
29.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
30.
Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271:134–9.CrossRef
31.
Saito S, Kobayashi T, Osawa T, Kato S. Effectiveness of Japanese herbal medicine yokukansan for alleviating psychiatric symptoms after traumatic brain injury. Psychogeriatrics. 2010;10(1):45–8.CrossRef
32.
Tsubo T, Nishimura M, Hashiba E, Ohkawa H, Harota K. The usage of Yokukansan as a sedative agent for patients in intensive care unit. Sci Kampo Med. 2013;37:272–4.
33.
Jabbar F, Leonard M, Meehan K, O’Connor M, Cronin C, Reynolds P, et al. Neuropsychiatric and cognitive profile of patients with DSM-IV delirium referred to an old age psychiatry consultation-liaison service. Int Psychogeriatr. 2011;23(7):1167–74.CrossRef
34.
Bhangle SD, Kramer N, Rosenstein ED. Corticosteroid-induced neuropsychiatric disorders: review and contrast with neuropsychiatric lupus. Rheumatol Int. 2013;33(8):1923–32.CrossRef
35.
Crane JH, Suda KJ. Oxycodone induced delirium and agitation in an elderly patient following total right knee arthroplasty. Int J Clin Pharm. 2011;33(5):733–6.CrossRef
36.
Fujii S, Tanimukai H, Kashiwagi Y. Comparison and analysis of delirium induced by histamine h(2) receptor antagonists and proton pump inhibitors in cancer patients. Case Rep Oncol. 2012;5(2):409–12.CrossRef
37.
Fukata S, Kawabata Y, Fujishiro K, Kitagawa Y, Kuroiwa K, Akiyama H, et al. Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial. Surg Today. 2017;47(7):815–26.CrossRef
38.
Bounds M, Kram S, Speroni KG, Brice K, Luschinski MA, Harte S, et al. Effect of ABCDE bundle implementation on prevalence of delirium in intensive care unit patients. Am J Crit Care. 2016;25(6):535–44.CrossRef
39.
Biere SS, van Berge Henegouwen MI, Mass KW, Bonavina L, Rosman C, Garcia JR, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomized controlled trial. Lancet. 2012;379:1887–1892.CrossRef
40.
Iwahashi M, Nakamori M, Nakamura M, Ojima T, Katsuda M, Iida T, et al. Clinical benefits of thoracoscopic esophagectomy in the prone position for esophageal cancer. Surg Today. 2014;44(9):1708–15.CrossRef
41.
Sudarshan M, Ferri L. A clinical review of minimally invasive esophagectomy. Surg Laparosc Endosc Percutan Tech. 2012;22:310–8.CrossRef
42.
Watanabe M, Baba Y, Nagai Y, Baba H. Minimally invasive esophagectomy for esophageal cancer: an updated review. Surg Today. 2013;43(3):237–44.CrossRef
43.
Uchihara T, Yoshida N, Baba Y, Yagi T, Toihata T, Oda E, et al. Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer. Surg Endosc. 2018;32(6):2852–8.CrossRef
44.
Colapinto ND. Is age alone a contraindication to major cancer surgery? Can J Surg. 1985;28(4):323–6.PubMed
45.
Barlow AP, Zarifa Z, Shillito RG, Crumplin MK, Edwards E, McCarthy JM. Surgery in a geriatric population. Ann R Coll Surg Engl. 1989;71(2):110–4.PubMedPubMedCentral
46.
Yoshida N, Nakamura K, Kuroda D, Baba Y, Miyamoto Y, Iwatsuki M, et al. Preoperative smoking cessation is integral to the prevention of postoperative morbidities in minimally invasive esophagectomy. World J Surg. 2018;42(9):2902–9.CrossRef
47.
Saeki H, Ishimura H, Higashi H, Kitagawa D, Tanaka J, Maruyama R, et al. Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy. Surg Today. 2009;39(6):476–80.CrossRef
48.
Valkenet K, Trappenburg JCA, Ruurda JP, Guinan EM, Reynolds JV, Nafteux P, et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg. 2018;105(5):502–11.CrossRef
49.
Balasundaram B, Holmes J. Delirium in vascular surgery. Eur J Vasc Endovasc Surg. 2007;34(2):131–4.CrossRef
50.
Dasgupta M, DumbrellAC. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc. 2006;54(10):1578–89.CrossRef
51.
Bilotta F, Lauretta MP, Borozdina A, Mizikov VM, Rosa G. Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol. 2013;79(9):1066–76.PubMed
52.
Takeuchi M, Takeuchi H, Fujisawa D, Miyajima K, Yoshimura K, Hashiguchi S, et al. Incidence and risk factors of postoperative delirium in patients with esophageal cancer. Ann Surg Oncol. 2012;19(12):3963–70.CrossRef
Metadata
Title
Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer
Authors
Masaki Ohi
Yuji Toiyama
Yusuke Omura
Takashi Ichikawa
Hiromi Yasuda
Yoshinaga Okugawa
Hiroyuki Fujikawa
Yoshiki Okita
Shigeyuki Yoshiyama
Junichiro Hiro
Toshimitsu Araki
Masato Kusunoki
Publication date
01-02-2019
Publisher
Springer Singapore
Published in
Surgery Today / Issue 2/2019
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-018-1721-0

Other articles of this Issue 2/2019

Surgery Today 2/2019 Go to the issue

Original Article

Combination of longitudinal pancreaticojejunostomy with coring-out of the pancreatic head (Frey procedure) and distal pancreatectomy for chronic pancreatitis

Original Article

Surgical outcomes of modified-maze procedures in adults with atrial septal defect

Original Article

Positron emission tomography/computed tomography as a clinical diagnostic tool for anterior mediastinal tumors

Review Article

Loop transverse colostomy versus loop ileostomy for defunctioning of colorectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis

Original Article

Three-port totally endoscopic repair vs conventional median sternotomy for atrial septal defect

Original Article

BRF2 as a promising indicator for radical lymph-node dissection surgery in patients with cN0 squamous cell carcinoma of the middle thoracic esophagus