Skip to main content
Erschienen in: Annals of Surgical Oncology 8/2019

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 | Ausgabe 8/2019

Einloggen, um Zugang zu erhalten

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240:791–800.CrossRefPubMedPubMedCentral Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240:791–800.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Yoshida N, Watanabe M, Baba Y, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44:526–32.CrossRefPubMed Yoshida N, Watanabe M, Baba Y, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44:526–32.CrossRefPubMed
3.
Zurück zum Zitat Shiozaki A, Fujiwara H, Okamura H, et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett. 2012;3:907–12.PubMedPubMedCentral Shiozaki A, Fujiwara H, Okamura H, et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett. 2012;3:907–12.PubMedPubMedCentral
4.
Zurück zum Zitat Molena D, Mungo B, Stem M, Lidor AO. Incidence and risk factors for respiratory complications in patients undergoing esophagectomy for malignancy: a NSQIP analysis. Semin Thorac Cardiovasc Surg. 2014;26: 287–94.CrossRefPubMed Molena D, Mungo B, Stem M, Lidor AO. Incidence and risk factors for respiratory complications in patients undergoing esophagectomy for malignancy: a NSQIP analysis. Semin Thorac Cardiovasc Surg. 2014;26: 287–94.CrossRefPubMed
5.
Zurück zum Zitat Takeuchi H, Miyata H, Gotoh M, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260:259–66.CrossRefPubMed Takeuchi H, Miyata H, Gotoh M, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260:259–66.CrossRefPubMed
6.
Zurück zum Zitat Zingg U, Smithers BM, Gotley DC, et al. Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol. 2011;18:146–8.CrossRef Zingg U, Smithers BM, Gotley DC, et al. Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol. 2011;18:146–8.CrossRef
7.
Zurück zum Zitat Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg. 2011;91:1494–500.CrossRefPubMed Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg. 2011;91:1494–500.CrossRefPubMed
8.
Zurück zum Zitat Yoshida N, Baba Y, Hiyoshi Y, et al. Duration of smoking cessation and postoperative morbidity after esophagectomy for esophageal cancer: how long should patients stop smoking before surgery? World J Surg. 2016;40:142–7.CrossRefPubMed Yoshida N, Baba Y, Hiyoshi Y, et al. Duration of smoking cessation and postoperative morbidity after esophagectomy for esophageal cancer: how long should patients stop smoking before surgery? World J Surg. 2016;40:142–7.CrossRefPubMed
9.
Zurück zum Zitat Yoshida N, Nakamura K, Kuroda D, et al. Preoperative smoking cessation is integral to the prevention of postoperative morbidities in minimally invasive esophagectomy. World J Surg. 2018;42:2902–9.CrossRefPubMed Yoshida N, Nakamura K, Kuroda D, et al. Preoperative smoking cessation is integral to the prevention of postoperative morbidities in minimally invasive esophagectomy. World J Surg. 2018;42:2902–9.CrossRefPubMed
11.
Zurück zum Zitat Uchihara T, Yoshida N, Baba Y, et al. Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer. Surg Endosc. 2018;32:2852–8.CrossRefPubMed Uchihara T, Yoshida N, Baba Y, et al. Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer. Surg Endosc. 2018;32:2852–8.CrossRefPubMed
13.
Zurück zum Zitat Sobin LH, Gospodarowicz MK, Wittekind C. International Union against Cancer. TNM classification of malignant tumours. 7th ed. Chichester: Wiley; 2010. Sobin LH, Gospodarowicz MK, Wittekind C. International Union against Cancer. TNM classification of malignant tumours. 7th ed. Chichester: Wiley; 2010.
14.
Zurück zum Zitat Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.CrossRefPubMed Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.CrossRefPubMed
15.
Zurück zum Zitat Yoshida N, Baba Y, Shigaki H, et al. Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg. 2018;40:1910–7.CrossRef Yoshida N, Baba Y, Shigaki H, et al. Preoperative nutritional assessment by controlling nutritional status (CONUT) is useful to estimate postoperative morbidity after esophagectomy for esophageal cancer. World J Surg. 2018;40:1910–7.CrossRef
16.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Yoshida N, Baba Y, Shigaki H, et al. Effect of esophagus position on surgical difficulty and postoperative morbidities after thoracoscopic esophagectomy. Semin Thorac Cardiovasc Surg. 2016;28:172–9.CrossRefPubMed Yoshida N, Baba Y, Shigaki H, et al. Effect of esophagus position on surgical difficulty and postoperative morbidities after thoracoscopic esophagectomy. Semin Thorac Cardiovasc Surg. 2016;28:172–9.CrossRefPubMed
18.
Zurück zum Zitat Inoue J, Ono R, Makiura D, et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2013;26:68–74.CrossRefPubMed Inoue J, Ono R, Makiura D, et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2013;26:68–74.CrossRefPubMed
19.
Zurück zum Zitat Yamana I, Takeno S, Hashimoto T, et al. Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig Surg. 2015;32:331–7.CrossRefPubMed Yamana I, Takeno S, Hashimoto T, et al. Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig Surg. 2015;32:331–7.CrossRefPubMed
20.
Zurück zum Zitat Nygren J, Soop M, Thorell A, Hausel J, Ljungqvist O. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients. Dis Colon Rectum. 2009;52:978–85.CrossRefPubMed Nygren J, Soop M, Thorell A, Hausel J, Ljungqvist O. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients. Dis Colon Rectum. 2009;52:978–85.CrossRefPubMed
21.
Zurück zum Zitat Markar SR, Karthikesalingam A, Low DE. Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis. Dis Esophagus. 2015;28:468–75.CrossRefPubMed Markar SR, Karthikesalingam A, Low DE. Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis. Dis Esophagus. 2015;28:468–75.CrossRefPubMed
22.
Zurück zum Zitat Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.CrossRefPubMed Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.CrossRefPubMed
Metadaten
Titel
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
Publikationsdatum
29.05.2019
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 8/2019
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07477-7

Weitere Artikel der Ausgabe 8/2019

Annals of Surgical Oncology 8/2019 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.