Clinical Importance of Sputum in the Respiratory Tract as a Predictive Marker of Postoperative Morbidity After Esophagectomy for Esophageal Cancer

Yoshida, Naoya; Morito, Atsushi; Nagai, Yoshinori; Baba, Yoshifumi; Miyamoto, Yuji; Iwagami, Shiro; Iwatsuki, Masaaki; Hiyoshi, Yukiharu; Eto, Kojiro; Ishimoto, Takatsugu; Kiyozumi, Yuki; Yagi, Taisuke; Nomoto, Daichi; Akiyama, Takahiko; Toihata, Tasuku; Imamura, Yu; Watanabe, Masayuki; Baba, Hideo

doi:10.1245/s10434-019-07477-7

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…Pulmonary morbidity is one of the most common morbidities after esophagectomy. Although the occurrence of pulmonary morbidity is gradually reducing, recent studies reported that it still occurs in 16%‐23% of cases 2–5 . Pulmonary morbidity is also a major cause of hospital mortality 6 and might be an independent risk factor for poorer long‐term survival 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Precautions for avoiding pulmonary morbidity after esophagectomy

Yoshida

Harada

Iwatsuki

et al. 2020

Annals of Gastroent Surgery

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Esophagectomy is the mainstay of multidisciplinary therapies for resectable esophageal cancer. However, esophagectomy is associated with higher morbidity and mortality rates compared to other gastrointestinal surgeries. 1-3 Pulmonary morbidity is one of the most common morbidities after esophagectomy. Although the occurrence of pulmonary morbidity is gradually reducing, recent studies reported that it still occurs in 16%-23% of cases. 2-5 Pulmonary morbidity is also a major cause of hospital mortality 6 and might be an independent risk factor for poorer long-term survival. 7,8 Thus, identifying the risk factors and preventing pulmonary morbidity is important to improve surgical outcomes in patients with resectable esophageal cancer. A comprehensive review of the precautionary measures that have so far been shown to be effective in previous literature is of utmost importance. Herein, we update and summarize methods that contribute to reducing pulmonary morbidity after esophagectomy based on recently published evidence. Representative data are summarized in Figure 1. 2 | S MOKING CE SSATI ON Smoking habit is one of the significant risk factors for pulmonary morbidities. 5,9-12 Notably, current smoking at the time of surgery contributes considerable risk. 5,11 Previous studies suggested that chances of occurrence of pneumonia increased as the duration of pre-operative smoking cessation became shorter. 13,14 The minimum duration for which patients should stop smoking before surgery to reduce pulmonary morbidity has not been established. We have reported that the duration of pre-operative smoking cessation should

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Section: Introductionmentioning

confidence: 99%

Precautions for avoiding pulmonary morbidity after esophagectomy

Yoshida

Harada

Iwatsuki

et al. 2020

Annals of Gastroent Surgery

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“…Most of the esophagus is located vertically, adjacent to the trachea, bronchi, aorta, and heart, all of which are vital organs for life support [ 1 ]. In addition, there is no serosa in the esophageal wall, and it is thought that esophageal cancer invades adjacent organs as it progresses [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of thoracotomy and thoracoscopic-assisted esophageal surgery in conversion and salvage surgeries: a retrospective study

et al. 2022

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Background The esophagus has no serosa; therefore, esophageal cancer may quickly invade its adjacent organs. In recent years, reports of conversion surgery (CS) and salvage surgery (SS) have described resection of esophageal cancer previously considered unresectable, with the addition of intensive preoperative chemotherapy or chemoradiotherapy. Currently, there is no established method for determining whether tumor excision is possible. Additionally, differences in surgical approaches between facilities may influence outcome after resection. However, the option for resection is considered a significant factor in determining a patient’s prognosis. Methods Patients who were diagnosed with advanced-stage (T3 or higher) squamous cell carcinoma of the esophagus and subsequently underwent resection with CS or SS were included in the study. Resection was performed through a small thoracotomy using a thoracoscope. Clinicopathologic factors, such as complete resection rate (R0) and prognosis, were investigated. Results A total of 49 surgeries were conducted: 39 CS and 10 SS cases. The male-to-female ratio was 37:12. R0:R1:R2 equals 42:3:4, and the R0 resection rate was 85.7%. The 5-year survival rates for CS and SS cases were 69.2% and 32.1%, respectively. The 5-year survival rates for R0, R1, and R2 resections were 63.4%, 0.0%, and 25.0%, and those for R0 and R1 + 2 resections were 63.4% and 14.3%, respectively, indicating that the prognosis for R0 resection cases was significantly better (P = 0.001 and P = 0.001, respectively). Regarding chemotherapy for CS, 29 patients received 5-FU and cisplatin therapy, whereas 10 patients received 5-FU, cisplatin, and docetaxel (DCF) therapy. After 2015, the ratio of DCF was significantly high, and the R0 resection rate was 100% in patients who received DCF therapy. Conclusions In this study, a satisfactory R0 rate was achieved using the magnifying effect of the thoracoscope while ensuring safety during thoracotomy. Trial registration This was a single-center cohort study wherein clinical data were retrospectively registered. This study was approved by the Chiba Cancer Center review board (H29-262). All procedures adhered to the ethical standards of the responsible committee on human experimentation and the Helsinki Declaration of 1964 and its later amendments.

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“…The weight of sputum is considered a predictive indicator of pulmonary complications (12). Several studies have indicated that sputum contains microorganisms that could cause diseases, such as pneumonia and systemic inflammatory response syndrome (7,13).…”

Section: Introductionmentioning

confidence: 99%

Effect of the Active Cycle of Breathing Technique on Perioperative Outcome in Individuals With Esophagectomy: A Quasi-Experimental Study

Zhang

Yang

et al. 2021

Front. Surg.

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Background: The effect of active cycle of breathing technique (ACBT) on EC patients has not been well elucidated. In this research, we aim to explore the effect of ACBT on the perioperative outcomes in patients with esophageal carcinoma who underwent esophagectomy.Methods: Patients who underwent esophagectomy in an academic institution from December 2017 to July 2019 were included in this study. In a quasi-experimental study, participants were randomly divided into an experimental group (active cycle of breathing technique, n = 107) and an observational group (n = 106) by drawing lots. The chi-squared test, Cochran–Mantel–Haenszel test, Logistic regression analysis, and Kruskal–Wallis test were used to analyze data. A two-sided P value <0.05 was considered statistically significant. The primary observational endpoint was the mean weight of the sputum. Other outcomes included the six-min-walk test (6MWT), Borg scale, anastomotic leakage, and the length of hospital stay.Results: 95 patients underwent minimally invasive surgery, and 118 patients received open surgery. There were 16 patients with anastomotic leakage in the present study, and we found that patients in the observational group had higher odds of anastomotic leakage. The results showed that the mean weight of the sputum in the observation group was lighter than that of the experimental group. After esophagectomy, the experimental group had better outcomes than the observation group (Borg scale: 2.448 vs. 1.547; 6-MWT: 372.811 vs. 425.355m, all P < 0.05). The mean length of hospital stay was longer in the observation group (17.953 days) than that in the experimental group (12.037 days, P = 0.01). We also found that the observational group had a higher discharge ratio over 2 weeks in all cohort (adjusted OR 2.487, 95% confidence intervals 1.147–5.392, P = 0.021).Conclusion: Active cycle of breathing technique may improve the perioperative outcomes and decrease the length of hospital stay after surgery in patients with esophageal cancer. However, we need more researches to validate these findings.

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Clinical Importance of Sputum in the Respiratory Tract as a Predictive Marker of Postoperative Morbidity After Esophagectomy for Esophageal Cancer

Cited by 10 publications

References 21 publications

Precautions for avoiding pulmonary morbidity after esophagectomy

Precautions for avoiding pulmonary morbidity after esophagectomy

Efficacy of thoracotomy and thoracoscopic-assisted esophageal surgery in conversion and salvage surgeries: a retrospective study

Effect of the Active Cycle of Breathing Technique on Perioperative Outcome in Individuals With Esophagectomy: A Quasi-Experimental Study

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