Skip to main content
SpringerLink
Log in

Clinical Outcomes of Preserving Bronchial Arteries During Radical Esophagectomy: A Propensity-Score Matched Analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postoperative pneumonia is a common and major cause of mortality after radical esophagectomy. Intraoperative preservation of the bronchial arteries is often aimed at avoiding tracheobronchial ischemia; however, it is unknown whether this contributes to a reduction in postoperative pneumonia.

Patients and Methods

We enrolled 348 consecutive patients who underwent radical esophagectomy for esophageal cancer at Toranomon Hospital from January 2011 to July 2018. We classified patients into a bronchial artery-resected (BA-R) group (n = 93) and a bronchial artery-preserved (BA-P) group (n = 255) and compared the incidence of postoperative pneumonia between the two groups. A propensity score-matching analysis for bronchial artery preservation versus resection was performed.

Results

Overall, 182 patients were matched. Univariate analysis of the propensity score-matched groups showed that Brinkman index ≥ 400, vital capacity (%VC) < 80%, and bronchial artery resection were associated with the development of postoperative pneumonia. Multivariate analysis revealed three significant factors associated with postoperative pneumonia: Brinkman index ≥ 400 [p = 0.006, odds ratio (HR) 3.302, 95% confidence interval (95% CI) 1.399–7.790], %VC < 80% (p = 0.034, HR 6.365, 95% CI 1.151–35.205), and bronchial artery resection (p = 0.034, HR 2.131, 95% CI 1.060–4.282). The incidence of postoperative complications (CD grade III) was higher in the BA-R group (BA-R 42.8% versus BA-P 27.5%, p = 0.030). There was no significant difference in overall survival between the two groups at 5 years (BA-R 63.1% versus BA-P 72.1%, p = 0.130).

Conclusion

Preserving the bronchial artery is associated with a decreased incidence of postoperative pneumonia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Zhu Z, Chen H, Yu W, et al. Number of negative lymph nodes is associated with survival in thoracic esophageal squamous cell carcinoma patients undergoing three-field lymphadenectomy. Ann Surg Oncol. 2014;21:2857–63. https://doi.org/10.1245/s10434-014-3665-y.

    Article  PubMed  Google Scholar 

  2. Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol. 2012;106:742–7.

    Article  PubMed  Google Scholar 

  3. Udagawa H, Akiyama H. Surgical treatment of esophageal cancer: Tokyo experience of the three-field technique. Dis Esophagus. 2001;14:110–4.

    Article  CAS  PubMed  Google Scholar 

  4. Isono K, Sato H, Nakayama K. Results of a nationwide study on the three-field lymph node dissection of esophageal cancer. Oncology. 1991;48:411–20.

    Article  CAS  PubMed  Google Scholar 

  5. Nafteux P, Depypere L, Van Veer H, Coosemans W, Lerut T. Principles of esophageal cancer surgery, including surgical approaches and optimal node dissection (2- vs. 3-field). Ann Cardiothorac Surg. 2017;6:152–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kataoka K, Takeuchi H, Mizusawa J, et al. Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: exploratory analysis of JCOG9907. Ann Surg. 2017;265:1152–7.

    Article  PubMed  Google Scholar 

  7. Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94:e1369.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Maruyama K, Motoyama S, Sato Y, et al. Tracheobronchial lesions following esophagectomy: erosions, ulcers, and fistulae, and the predictive value of lymph node-related factors. World J Surg. 2009;33:778–84.

    Article  PubMed  Google Scholar 

  9. Kusano C, Baba M, Tanabe G, et al. A study on the changes in the tracheo-bronchial mucosa after esophagectomy for esophageal cancer; with special reference to the influence of neck and upper mediastinal lymph node dissections. Nihon Geka Gakkai Zasshi. 1989;90:1866–72.

    CAS  PubMed  Google Scholar 

  10. Fujita H, Hawahara H, Yamana H, et al. Mediastinal lymphnode dissection procedure during esophageal cancer operation–carefully considered for preserving respiratory function. Jpn J Surg. 1988;18:31–4.

    Article  CAS  PubMed  Google Scholar 

  11. Pramesh CS, Mistry RC, Sharma S, Pantvaidya GH, Raina S. Bronchial artery preservation during transthoracic esophagectomy. J Surg Oncol. 2004;85:202–3.

    Article  CAS  PubMed  Google Scholar 

  12. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. New York: Wiley; 2011.

    Google Scholar 

  13. Udagawa H, Ueno M, Shinohara H, et al. Should lymph nodes along the thoracic duct be dissected routinely in radical esophagectomy? Esophagus. 2014;11:204–10.

    Article  Google Scholar 

  14. Fujisawa K, Ohkura Y, Ueno M, Yago A, Shimoyama H, Udagawa H. Nutritional outcomes of thoracic duct resection for radical esophagectomy by assessing body composition changes in one year: a single-center retrospective study. Ann Surg Oncol. 2021;28:8414–25. https://doi.org/10.1245/s10434-021-10222-8.

    Article  PubMed  Google Scholar 

  15. Ohkura Y, Ueno M, Shindoh J, Iizuka T, Ka H, Udagawa H. Risk factors for postoperative chylothorax after radical subtotal esophagectomy. Ann Surg Oncol. 2018;25:2739–46. https://doi.org/10.1245/s10434-018-6640-1.

    Article  PubMed  Google Scholar 

  16. Wada T, Takeuchi H, Kawakubo H, et al. Clinical utility of preoperative evaluation of bronchial arteries by three-dimensional computed tomographic angiography for esophageal cancer surgery. Dis Esophagus. 2013;26:616–22.

    Article  CAS  PubMed  Google Scholar 

  17. Morita Y, Takase K, Ichikawa H, et al. Bronchial artery anatomy: preoperative 3D simulation with multidetector CT. Radiology. 2010;255:934–43.

    Article  PubMed  Google Scholar 

  18. Ajani JA, Winter K, Komaki R, et al. Phase II randomized trial of two nonoperative regimens of induction chemotherapy followed by chemoradiation in patients with localized carcinoma of the esophagus: RTOG 0113. J Clin Oncol. 2008;26:4551–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kiyozumi Y, Yoshida N, Ishimoto T, et al. Prognostic factors of salvage esophagectomy for residual or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. World J Surg. 2018;42:2887–93.

    Article  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kojima S, Sakakibara H, Motani S, et al. Incidence of chronic obstructive pulmonary disease, and the relationship between age and smoking in a Japanese population. J Epidemiol. 2007;17:54–60.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tamagawa A, Aoyama T, Tamagawa H, et al. Influence of postoperative pneumonia on esophageal cancer survival and recurrence. Anticancer Res. 2019;39:2671–8.

    Article  PubMed  Google Scholar 

  23. Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg. 2011;91:1494–500.

    Article  PubMed  Google Scholar 

  24. Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002;123:661–9.

    Article  PubMed  Google Scholar 

  25. Blencowe NS, Strong S, McNair AG, et al. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Ann Surg. 2012;255:658–66.

    Article  PubMed  Google Scholar 

  26. Paul DJ, Jamieson GG, Watson DI, Devitt PG, Game PA. Perioperative risk analysis for acute respiratory distress syndrome after elective oesophagectomy. ANZ J Surg. 2011;81:700–6.

    Article  PubMed  Google Scholar 

  27. Zingg U, Smithers BM, Gotley DC, et al. Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol. 2011;18:1460–8. https://doi.org/10.1245/s10434-010-1474-5.

    Article  PubMed  Google Scholar 

  28. Sugimura K, Miyata H, Shinno N, et al. Indocyanine green fluorescence imaging of the tracheal blood flow during esophagectomy. J Surg Res. 2019;241:1–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Editage (www.editage.com) for English language editing.

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan

    Kentoku Fujisawa MD, Yu Ohkura MD, PhD, Masaki Ueno MD, PhD, Yusuke Ogawa MD, Hayato Shimoyama MD, PhD, Shusuke Haruta MD, PhD & Harushi Udagawa MD, PhD

Authors
  1. Kentoku Fujisawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Ohkura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masaki Ueno MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yusuke Ogawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hayato Shimoyama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shusuke Haruta MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harushi Udagawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KF, YO, and MU designed the study, wrote the manuscript, revised it critically for important intellectual content, and provided final approval for the content; KF, YO, MU, YO, HS, SH, and HU created study materials or recruited patients.

Corresponding author

Correspondence to Kentoku Fujisawa MD.

Ethics declarations

Disclosure

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 745 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujisawa, K., Ohkura, Y., Ueno, M. et al. Clinical Outcomes of Preserving Bronchial Arteries During Radical Esophagectomy: A Propensity-Score Matched Analysis. Ann Surg Oncol 31, 827–837 (2024). https://doi.org/10.1245/s10434-023-14495-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-14495-z

Keywords

Search

Navigation