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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

references:
Wormuth JK, Heitmiler RF. Esophageal conduit necrosis. Thorac Surg Clin 2006; 16: 11-22.
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.
Meng F, Li Y, Ma H, et al. Comparison of outcomes of open and minimally invasive esophagectomy in 183 patients with cancer. J Thorac Dis 2014; 6: 1218-24.
Zhai C, Liu Y, Li W, et al. A  comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy. J Thorac Dis 2015; 7: 2352-8.
Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a  multicentre, open-label, randomized controlled trial. Lancet 2012; 379: 1887-92.
Ott K, Bader FG, Lordick F, et al. Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a  consecutive series of 240 patient at an experienced center. Ann Surg Oncol 2009; 16: 1017-25.
Atkins BZ, Shan AS, Kelley A, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004; 78: 1170-6.
Wlodarczyk J, Kużdżał J. Stenting as a  palliative method in the management of advanced squamous cell carcinoma of the oesophagus and gastro-oesophageal junction. Videosurgery Miniinv 2016; 11: 1-8.
Zhang Z, Zhang H. Impact of neoadjuvant chemotherapy and chemoradiotherapy on postoperative cardiopulmonary complications in patiens with esophageal cancer. Dis Esophagus 2017; 30: 1-7.
Dumont P, Wihlm JM, Hentz JG, et al. Respiratory complications after surgical treatment of esophageal cancer. A  study of 309 patients according to the type of resection. Eur J Cardiothorac Surg 1995; 9: 539-43.
Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg 2002; 123: 661-9.
Baba M, Aikou T, Yoshinaka H, et al. Low-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus. Ann Surg 1994; 219: 108-13.
Dahn D, Martell J, Vorwerk H, et al. Influence of irradiated lung volumes on perioperative morbidity and mortality in patients after neoadjuvant radiochemotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys 2010; 77: 44-52.
Xing XZ, Gao Y, Wang HJ, et al. Assessment of a  predictive score for pulmonary complications in cancer patients after esophagectomy. World J Emerg Med 2016; 7: 44-9.
Tandon S,  Batchelor A, Bullock R, et al. Perioperative risk factor for acute lung injury after elective esophagectomy. Br J Anesth 2001; 86: 633-8.
Bartels H, Stein HJ, Siewert JR. Risk analysis in esophageal surgery. Recent Result Cancer Res 2000; 155: 89-96.
Dumont P, Wihlm JM, Hentz JG, et al. Respiratory complications after surgical treatment of esophageal cancer A  study of 309 patients according to the type of resection. Eur J Cardiothorac Surg 1995; 9: 539-43.
Horáková M, Lubušká L, Kolář K, et al. Individualized prophylaxis in patients with esophageal replacement for cancer. Surg Infect 2015; 16: 513-7.
Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy complications consensus group (ECCG). Ann Surg 2015; 262: 286-94.
Wiedermann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Eng J Med 2006; 354: 256-75.
Łochowski MP, Kozak J. Video-assisted thoracic surgery complications. Videosurgery Miniinv 2014; 9: 495-500.
Wan J, Che Y, Kang N, Zhang R. Surgical method, postoperative complications, and gastrointestinal motility of thoraco-laparoscopy 3-field esophagectomy in treatment of esophageal cancer. Med Sci Monit 2016; 22: 2056-65.
Baba Y, Yoshida N, Shigaki H, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a  retrospective single-institution study. Ann Surg 2016; 264: 305-11.
Lerut T, Moons J, Coosemans W, et al. Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg 2009; 25: 798-807.
  
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