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Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer

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Abstract

Background

Pulmonary morbidities after esophagectomy are still common and are a major cause of surgery-related mortality. The relationship between minimally invasive esophagectomy (MIE) and pulmonary morbidities is not clear. The current study aimed to examine the incidence of pulmonary morbidities after MIE and to clarify the associated risk factors.

Methods

Between May 2011 and December 2016, 184 patients underwent MIE for esophageal cancer. Clinical data were prospectively collected and analyzed. Patient- and surgery-related factors, relating to pulmonary complications, were compared between the complicated and uncomplicated cases.

Results

The incidence of any pulmonary morbidity following MIE was 17.9%. Univariate analysis showed that past heavy smoking [Brinkman index (BI) ≥ 1000], presence of neoadjuvant therapy, advanced clinical stage (stage III, IV), and intraoperative bleeding ≥ 600 g were candidates for being postoperative pulmonary morbidity risk factors. Multivariate analysis suggested that BI ≥ 1000 and advanced clinical stage were independent risk factors for causing pulmonary morbidities.

Conclusions

Past heavy smoking and advanced stage are independent risk factors for pulmonary morbidities after MIE. When performing MIE for such cases, various preoperative precautions and careful postoperative monitoring are necessary.

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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

    Tomoyuki Uchihara, Naoya Yoshida, Yoshifumi Baba, Taisuke Yagi, Tasuku Toihata, Eri Oda, Daisuke Kuroda, Tsugio Eto, Mayuko Ohuchi, Kenichi Nakamura, Hiroshi Sawayama, Koichi Kinoshita, Masaaki Iwatsuki, Takatsugu Ishimoto, Yasuo Sakamoto & Hideo Baba

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  1. Tomoyuki Uchihara
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  2. Naoya Yoshida
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  3. Yoshifumi Baba
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  4. Taisuke Yagi
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  13. Masaaki Iwatsuki
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  14. Takatsugu Ishimoto
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  15. Yasuo Sakamoto
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  16. Hideo Baba
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Correspondence to Hideo Baba.

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Disclosures

Drs. Uchihara, Yoshida, Baba, Yagi, Toihata, Oda, Kuroda, Eto, Ohuchi, Nakamura, Sawayama, Kinoshita, Iwatsuki, Sakamoto, and Baba have no conflicts of interest or financial ties to disclose.

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Uchihara, T., Yoshida, N., Baba, Y. et al. Risk factors for pulmonary morbidities after minimally invasive esophagectomy for esophageal cancer. Surg Endosc 32, 2852–2858 (2018). https://doi.org/10.1007/s00464-017-5993-z

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