Respiratory complications following minimally invasive esophagectomy: associated factors and predictive value of lung age
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Published on: May 26, 2023
Binh Van Pham1,2, Duy Duc Nguyen1, An Duc Thai1
1Department of Abdominal Surgery 1, Vietnam National Cancer Hospital, Hanoi, Vietnam.
Background:
Postoperative complications following esophageal surgery are severe, with respiratory complications being the most common. This study aims to evaluate the rate of respiratory complications and related factors post-esophagectomy and lymph node dissection for esophageal squamous cell carcinoma (ESCC).
Subjects And Methods:
A prospective cross-sectional study was conducted from October 2022 to March 2024 on ESCC who underwent minimally invasive esophagectomy and extended two-field lymph node dissection.
Results:
Pneumonia was observed in 18 cases (25.7%), with 15 cases recorded as Clavien-Dindo grade II, 2 cases as grade III, and 1 case as grade IV. There were no deaths within 120 days postoperative. Factors significantly affected the respiratory complications, including recurrent laryngeal nerve (RLN) palsy (P = 0.02), lung age (P = 0.04), lung-age and real-age (L-R) difference-L-R (P = 0.03), FEV1 (P = 0.045), and the obstructive/restrictive lung disease (P = 0.015). The average intensive care unit stay and hospital stay were longer in the group with respiratory complications (P = 0.000 and P = 0.001, respectively). Lung age and the L-R difference were more predictive of respiratory complications than FEV1, FEV1%, and Tiffeneau index (P < 0.05, AUC > 0.5). Thresholds of ≥23.7 years for L-R difference and ≥76.4 years for lung age were identified as predictive.
Conclusion:
Respiratory complications are common following esophageal cancer surgery, with a rate of 25.7%. Factors affecting the incidence of respiratory complications include RLN palsy, pulmonary age, L-R difference, FEV1, and the obstructive/restrictive lung disease. Lung age and the L-R difference were more predictive of respiratory complications than FEV1, FEV1%, and Tiffeneau index.
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