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Postoperative respiratory morbidity can adversely affect prognosis in thoracoscopic esophagectomy for esophageal cancer: a retrospective study

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Abstract

Background

Esophagectomy for esophageal cancer is associated with frequent respiratory morbidities, which may deteriorate postoperative survival outcomes. Thoracoscopic esophagectomy (TE) is less invasive and is associated with fewer respiratory morbidities than open esophagectomy. However, the relationship between post-TE respiratory morbidity and prognosis has not been well established.

Methods

This study included 378 patients who underwent TE for esophageal cancer between May 2011 and November 2020. Patients were divided into two groups based on the presence of respiratory morbidity. Short-term and long-term outcomes of the groups were retrospectively compared.

Results

Respiratory morbidity was significantly associated with heavy past smoking habits (Brinkman index, p = 0.0039), short duration of smoking cessation (p = 0.0012), worse American Society of Anesthesiologists physical status (p = 0.016), frequent cardiovascular comorbidities (p = 0.0085), and long hospital stay (p < 0.001). Respiratory morbidity significantly deteriorated overall survival (OS) (p = 0.011) and relapse-free survival (p = 0.062) and could be an independent prognostic factor for OS (hazard ratio = 1.90, 95% confidence interval = 1.093–3.311, p = 0.023) along with clinical stage.

Conclusion

Respiratory morbidity can adversely affect prognosis after TE. Various prophylaxes for respiratory morbidity are required to improve the short-term and long-term outcomes of TE for esophageal cancer.

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Acknowledgements

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan

    Tomo Horinouchi, Naoya Yoshida, Tasuku Toihata, Kazuto Harada, Kojiro Eto, Katsuhiro Ogawa, Hiroshi Sawayama, Masaaki Iwatsuki, Yoshifumi Baba, Yuji Miyamoto & Hideo Baba

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  1. Tomo Horinouchi
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  2. Naoya Yoshida
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  3. Tasuku Toihata
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  4. Kazuto Harada
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  5. Kojiro Eto
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  9. Yoshifumi Baba
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Correspondence to Hideo Baba.

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Drs. Tomo Horinouchi, Naoya Yoshida, Tasuku Toihata, Kazuto Harada, Kojiro Eto, Katsuhiro Ogawa, Hiroshi Sawayama, Masaaki Iwatsuki, Yoshifumi Baba, Yuji Miyamoto, and Hideo Baba have no conflicts of interest or financial ties to disclose.

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Horinouchi, T., Yoshida, N., Toihata, T. et al. Postoperative respiratory morbidity can adversely affect prognosis in thoracoscopic esophagectomy for esophageal cancer: a retrospective study. Surg Endosc 37, 2104–2111 (2023). https://doi.org/10.1007/s00464-022-09711-y

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  • DOI: https://doi.org/10.1007/s00464-022-09711-y

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