Erschienen in:
29.05.2019 | Gastrointestinal Oncology
Clinical Importance of Sputum in the Respiratory Tract as a Predictive Marker of Postoperative Morbidity After Esophagectomy for Esophageal Cancer
verfasst von:
Naoya Yoshida, MD, PhD, Atsushi Morito, MD, Yohei Nagai, MD, PhD, Yoshifumi Baba, MD, PhD, Yuji Miyamoto, MD, PhD, Shiro Iwagami, MD, PhD, Masaaki Iwatsuki, MD, PhD, Yukiharu Hiyoshi, MD, PhD, Kojiro Eto, MD, PhD, Takatsugu Ishimoto, MD, PhD, Yuki Kiyozumi, MD, PhD, Taisuke Yagi, MD, Daichi Nomoto, MD, Takahiko Akiyama, MD, Tasuku Toihata, MD, Yu Imamura, MD, PhD, Masayuki Watanabe, MD, PhD, Hideo Baba, MD, PhD
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 8/2019
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Abstract
Background
Respiratory morbidity is common after esophagectomy and can be a major cause of surgery-related mortality. Thus, it is important to identify novel predictors that can preoperatively estimate the incidence of postoperative respiratory morbidity. Asymptomatic sputum in the respiratory tract is sometimes observed on preoperative computed tomography (CT). This study aimed to determine the clinical importance of sputum in the respiratory tract as a predictor of postoperative morbidity after esophagectomy for esophageal cancer.
Patients and Methods
The study included 609 consecutive patients who underwent three-incisional esophagectomy for esophageal cancer between April 2005 and November 2018.
Results
Among the patients, 76 (12.5%) had sputum in the respiratory tract on preoperative CT. This finding was significantly associated with older age, more extreme smoking habit, worse performance status, lower forced expiratory volume 1%, and more frequent pulmonary comorbidities. Additionally, the incidence of postoperative pneumonia was higher in these patients than in those without sputum (16 vs 8%, p = 0.028). Sputum in the main bronchus was associated with higher frequencies of morbidity of Clavien–Dindo classification (CDc) ≥ II (p = 0.019), severe morbidity of CDc ≥ IIIb (p = 0.058), pneumonia (p = 0.10), and pulmonary morbidity (p = 0.19) compared with the finding of sputum in the trachea alone. On multivariate analysis, sputum in the respiratory tract was an independent risk factor (hazard ratio, 2.07; 95% confidence interval, 1.019–4.207; p = 0.044) for postoperative pneumonia.
Conclusions
Sputum in the respiratory tract is a novel predictor of postesophagectomy pneumonia. Patients with sputum in the more distal respiratory tract might have high risk of postoperative morbidities.