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An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer

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Abstract

Background

Pulmonary complications occur most frequently following a transthoracic esophagectomy for esophageal cancer and would get to be lethal occasionally. In this study, we sought to determine the effect of respiratory physiotherapy, corticosteroid administration, and the use of the video-assisted thoracoscopic (VATS) esophagectomy with a small thoracotomy incision, on the incidence of pulmonary complications following a transthoracic subtotal esophagectomy.

Materials and methods

Approximately 184 patients who had undergone a right transthoracic subtotal esophagectomy for squamous cell carcinoma of the thoracic esophagus were studied. To reduce the incidence of pulmonary complications, we performed clinical trials using respiratory physiotherapy, corticosteroid administration, and the VATS-esophagectomy surgical technique.

Results

The independent risk factors for pulmonary complications in the multivariate logistic regression analysis were not administering corticosteroids, blood loss greater than 630 ml, and not providing respiratory physiotherapy. In addition, the use of a small surgical incision, less than 10 cm, for the thoracotomy had no effect on the prevention of pulmonary complications.

Conclusions

We concluded that patients with thoracic esophageal cancer could undergo a three-field dissection in comparative safety if the patients were provided with corticosteroid medication in the perioperative period, if the patients received sufficient respiratory physiotherapy, and if surgical blood loss was reduced.

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Abbreviations

ARDS:

acute respiratory distress syndrome

ICU:

Intensive Care Unit

OR:

odds ratio

CI:

confidence interval

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Masaki Nakamura, Makoto Iwahashi, Mikihito Nakamori, Koichiro Ishida, Teiji Naka, Takeshi Iida, Masahiro Katsuda, Toshiaki Tsuji, Yoshihiro Nakatani & Hiroki Yamaue

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  1. Masaki Nakamura
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  2. Makoto Iwahashi
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  3. Mikihito Nakamori
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  4. Koichiro Ishida
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  5. Teiji Naka
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  6. Takeshi Iida
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  7. Masahiro Katsuda
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  8. Toshiaki Tsuji
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  9. Yoshihiro Nakatani
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  10. Hiroki Yamaue
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Corresponding author

Correspondence to Hiroki Yamaue.

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Nakamura, M., Iwahashi, M., Nakamori, M. et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg 393, 127–133 (2008). https://doi.org/10.1007/s00423-007-0253-7

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  • DOI: https://doi.org/10.1007/s00423-007-0253-7

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