Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer

Zingg, Urs, Smithers, Bernard M., Gotley, David C., Smith, Garett, Aly, Ahmad, Clough, Anthony, Esterman, Adrian J., Jamieson, Glyn G. and Watson, David I. (2011) Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Annals of Surgical Oncology, 18 5: 1460-1468. doi:10.1245/s10434-010-1474-5

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Author Zingg, Urs
Smithers, Bernard M.
Gotley, David C.
Smith, Garett
Aly, Ahmad
Clough, Anthony
Esterman, Adrian J.
Jamieson, Glyn G.
Watson, David I.
Title Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer
Journal name Annals of Surgical Oncology   Check publisher's open access policy
ISSN 1068-9265
Publication date 2011
Year available 2010
Sub-type Article (original research)
DOI 10.1245/s10434-010-1474-5
Volume 18
Issue 5
Start page 1460
End page 1468
Total pages 9
Place of publication United States
Publisher Springer New York LLC
Collection year 2011
Language eng
Formatted abstract
Most studies analyzing risk factors for pulmonary morbidity date from the early 1990s. Changes in technology and treatment such as minimally invasive esophagectomy (MIE) and neoadjuvant treatment mandate analysis of more contemporary cohorts.

Predictive factors for overall and specific pulmonary morbidity in 858 patients undergoing esophagectomy between 1998 and 2008 in five Australian university hospitals were analyzed by logistic regression models.

A total of 394 patients underwent open esophagectomy, and 464 patients underwent MIE. A total of 259 patients received neoadjuvant chemoradiotherapy, 139 preoperative chemotherapy alone, and 2 preoperative radiotherapy alone. In-hospital mortality was 3.5%. Smoking and the number of comorbidities were risk factors for overall pulmonary morbidity (odds ratio [OR] 1.47, P = 0.016; OR 1.35, P = 0.001) and pneumonia (OR 2.29, P = 0.002; 1.56, P = 0.005). The risk of respiratory failure was higher in patients with more comorbidities (OR 1.4, P = 0.035). Respiratory comorbidities (OR 3.81, P = 0.017) were strongly predictive of postoperative acute respiratory distress syndrome (ARDS). ARDS (4.51, P = 0.032) or respiratory failure (OR 8.7, P < 0.001), but not anastomotic leak (OR 2.22, P = 0.074), were independent risk factors for death. MIE (OR 0.11, P < 0.001) and thoracic epidural analgesia (OR 0.12, P = 0.003) decreased the risk of respiratory failure. Neoadjuvant treatment was not associated with an increased risk of pulmonary complications.

Preoperative comorbidity and smoking were risk factors for respiratory complications, whereas neoadjuvant treatment was not. MIE and the use of thoracic epidural analgesia decreased the risk of respiratory failure. Respiratory failure and ARDS were the only independent factors associated with an increased risk of in-hospital death, whereas anastomotic leakage was not. © 2010 Society of Surgical Oncology.
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Institutional Status UQ
Additional Notes Published Online: 24 December 2010

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 47 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 17 Mar 2011, 16:05:15 EST by Mrs Maureen Pollard on behalf of PA - Southside Clinical School