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Early postoperative pulmonary complications after minimally invasive esophagectomy in the prone position: incidence and perioperative risk factors from the perspective of anesthetic management

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A Letter to the Editor to this article was published on 26 August 2022

Abstract

Objectives

To investigate the incidence of and the risk factors for early postoperative pulmonary complications (PPC) after minimally invasive esophagectomy (MIE) in the prone position from the perspective of anesthetic management.

Methods

We conducted a historical cohort study of patients who underwent MIE in the prone position between September 2010 and August 2018. PPC was defined as pneumonia, atelectasis, acute respiratory distress syndrome (ARDS), respiratory failure, and pulmonary embolism (Clavien–Dindo Classification Grade II or higher) that occurred within 7 days after MIE.

Results

Out of 489 patients, there were 90 patients (18.4%) with PPC: 75 patients with pneumonia, 24 patients with atelectasis, 13 patients with respiratory failure, 6 patients with ARDS, and 2 patients with pulmonary embolism. Twenty-eight patients suffered from 2 or more components of PPC. PPC patients were older (66.6 vs. 63.6 year, P = 0.038) and had higher amount of crystalloid (4200 vs. 3550 mL, P < 0.0001), and longer duration of anesthesia (670 vs. 625 min, P = 0.0062) than non-PPC patients. PPC patients were more likely to have had chronic obstructive pulmonary disease (COPD) (26.7 vs. 7.8%, P < 0.001). Incidence of PPC was significantly higher in patients with one-lung ventilation than with two-lung ventilation (37.1 vs. 15.3%, P < 0.001). Multivariable logistic regression analysis showed that PPC was associated with age (per 10 years, odds ratio (OR) = 1.41), COPD (OR = 3.43), one-lung ventilation (OR = 1.94), and volume of crystalloid (per 500 mL, OR = 1.22).

Conclusions

Two-lung rather than one-lung ventilation should be chosen and fluid overload should be avoided in patients undergoing MIE in the prone position.

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Funding

This work was funded by the Department of Anesthesiology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan.

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Authors and Affiliations

  1. Department of Anesthesiology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Seiji Ishikawa, Shojiro Ozato, Toshiaki Ebina, Sayaka Yoshioka, Mitsuhisa Miichi & Miyuki Yokota

  2. Department of Anesthesiology and Pain Clinic, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Seiji Ishikawa

  3. Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Masayuki Watanabe

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  1. Seiji Ishikawa
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  2. Shojiro Ozato
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  3. Toshiaki Ebina
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  4. Sayaka Yoshioka
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  5. Mitsuhisa Miichi
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Correspondence to Seiji Ishikawa.

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Ishikawa, S., Ozato, S., Ebina, T. et al. Early postoperative pulmonary complications after minimally invasive esophagectomy in the prone position: incidence and perioperative risk factors from the perspective of anesthetic management. Gen Thorac Cardiovasc Surg 70, 659–667 (2022). https://doi.org/10.1007/s11748-022-01818-2

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