Clinical Importance of Sputum in the Respiratory Tract as a Predictive Marker of Postoperative Morbidity After Esophagectomy for Esophageal Cancer

Journal Article · Thu Aug 15 04:00:00 EDT 2019 · Annals of Surgical Oncology (Online)

DOI:https://doi.org/10.1245/S10434-019-07477-7· OSTI ID:22927642

Yoshida, Naoya; Morito, Atsushi; Nagai, Yohei; Baba, Yoshifumi; Miyamoto, Yuji; Iwagami, Shiro; Iwatsuki, Masaaki; Hiyoshi, Yukiharu; Eto, Kojiro; Ishimoto, Takatsugu; Kiyozumi, Yuki; Yagi, Taisuke; Nomoto, Daichi; Akiyama, Takahiko ^[1]; Toihata, Tasuku; Imamura, Yu; Watanabe, Masayuki ^[2]; Baba, Hideo ^[1]

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1. Kumamoto University, Department of Gastroenterological Surgery, Graduate School of Medical Sciences (Japan)
2. Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Gastroenterological Surgery (Japan)

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.

• OSTI ID: 22927642
• Journal Information: Annals of Surgical Oncology (Online), Journal Name: Annals of Surgical Oncology (Online) Journal Issue: 8 Vol. 26; ISSN 1534-4681
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
COMPUTERIZED TOMOGRAPHY
DISEASE INCIDENCE
ESOPHAGUS
HAZARDS
MULTIVARIATE ANALYSIS
NEOPLASMS
PATIENTS
PNEUMONIA
SMOKES