eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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1/2019
vol. 14
 
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abstract:
Original paper

Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients

Radek Vrba, David Vrána, Čestmír Neoral, Bohuslav Melichar, René Aujeský, Jana Tesarikova, Jan Cincibuch, Jana Zapletalová, Tomáš Jínek, Martin Stašek

Videosurgery Miniinv 2019; 14 (1): 52–59
Online publish date: 2018/07/24
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Introduction
Respiratory complications (RC) including respiratory failure and adult respiratory distress syndrome (ARDS) affect the outcomes of esophagectomy substantially. In order to decrease their incidence, identification of important features of RC is necessary.

Aim
To evaluate the incidence and risk factors of postoperative RC following hybrid esophagectomy.

Material and methods
The retrospective analysis of consecutive hybrid esophagectomies for malignancies (trans­hiatal laparoscopic or thoracoscopic resection and limited open reconstruction phase) assessed the incidence and outcomes of RC in relation to the patients’ age, ASA score, neoadjuvant therapy, type of surgical procedure, TNM stage, the incidence of anastomotic leak and Clavien-Dindo classification.

Results
Transhiatal laparoscopic (176, 81.9%) or thoracoscopic hybrid esophagectomy (39, 18.1%, conversion in 7 patients) was completed in 215 patients, 187 (87%) men and 28 (13%) women. Respiratory complications developed in 86 (40%) and severe respiratory failure or ARDS occurred in 29 (13.5%) patients. The overall in-hospital mortality was 7.4%, 30-day mortality 5.6% (RC 9, myocardial infarction 1, conduit necrosis 1), and 90-day mortality a further 1.8% (multiple organ failure, ARDS). The incidence of RC correlates significantly with ASA score II and III (p = 0.0002) and Clavien-Dindo grade 4 and 5 in severe RC (p < 0.0001). Furthermore, hospital stay (p < 0.0001) and mortality (p < 0.0001) were significantly increased in RC.

Conclusions
The results show a higher occurrence of RC in polymorbid patients and patients with severe complications according to the Clavien-Dindo classification. Adequate risk management including surgical technique and perioperative prophylaxis and therapy of RC should be studied and standardized.

keywords:

neoadjuvant therapy, esophagectomy complication, respiratory complication, esophageal cancer therapy

  
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