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Community-acquired Pneumonia during Long-term Follow-up of Patients after Radical Esophagectomy for Esophageal Cancer: Analysis of Incidence and Associated Risk Factors

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Abstract

Background

There are no data concerning the occurrence of community-acquired pneumonia (CAP) in esophageal cancer patients during long-term follow-up after radical esophagectomy. The aims of the present study were to determine the incidence of CAP in esophageal cancer patients who underwent radical esophagectomy and to identify the risk factors.

Methods

A total of 186 consecutive patients who underwent radical esophagectomy for thoracic esophageal carcinoma in our hospital between 1991 and 2000 were enrolled in this study. Data on the occurrence of CAP were retrospectively collected from medical records, follow-up files, and telephone interviews with patients. The cumulative incidence of CAP was calculated by the Kaplan–Meier method, and the risk factors for CAP were determined by univariate and multivariate analyses. The median follow-up time was 77 months (range 12–216 months).

Results

Sixty patients suffered from CAP during the follow-up period. The cumulative incidence was 25.8% at 5 years and 38.4% at 10 years. Multivariate analysis revealed the following as the significant risk factors for CAP: presence of lymph node metastasis (Hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.55–4.50; P < 0.001), colonic interposition (HR, 2.87; 95% CI, 1.41–5.82; P = 0.004), obstructive lung disease (HR, 1.95; 95% CI, 1.11–3.42; P = 0.021), and preoperative hypoalbuminemia (HR, 2.08; 95% CI, 1.20–3.60; P = 0.009).

Conclusions

There is a high incidence of CAP in esophageal cancer patients after esophagectomy. Positive nodal metastasis, colonic interposition, obstructive lung disease, and preoperative hypoalbuminemia are risk factors for this long-term postoperative morbidity.

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Acknowledgments

The authors are grateful to M. Hitomi of The Lerner Research Institute, Cleveland, OH, for helpful advice and suggestions. This study was supported by Grants from the Japanese Ministry of Health, Labour, and Welfare.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori 1-757, Niigata, 951-8510, Japan

    Takaaki Hanyu, Tatsuo Kanda, Kazuhito Yajima, Shin-ichi Kosugi & Katsuyoshi Hatakeyama

  2. Division of Clinical Infection Control and Prevention, Niigata University Medical and Dental Hospital, Asahimachi-dori 1-754, Niigata, 951-8520, Japan

    Yoshinari Tanabe

  3. Department of Surgery, Niigata Medical Center, Kobari 3-27-11, Niigata, 950-2022, Japan

    Shintaro Komukai

  4. Department of Nursing, School of Health Sciences, Niigata University, Asahimachi-dori 2-746, Niigata, 951-8518, Japan

    Tsutomu Suzuki

Authors
  1. Takaaki Hanyu
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  2. Tatsuo Kanda
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  3. Kazuhito Yajima
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  4. Yoshinari Tanabe
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  5. Shintaro Komukai
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  6. Shin-ichi Kosugi
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  7. Tsutomu Suzuki
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  8. Katsuyoshi Hatakeyama
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Corresponding author

Correspondence to Tatsuo Kanda.

Additional information

Takaaki Hanyu and Tatsuo Kanda should be considered equal first authors.

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Hanyu, T., Kanda, T., Yajima, K. et al. Community-acquired Pneumonia during Long-term Follow-up of Patients after Radical Esophagectomy for Esophageal Cancer: Analysis of Incidence and Associated Risk Factors. World J Surg 35, 2454–2462 (2011). https://doi.org/10.1007/s00268-011-1226-0

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  • DOI: https://doi.org/10.1007/s00268-011-1226-0

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