Postoperative pulmonary complications in patients with esophageal cancer

Abstract

There are recent reports on postoperative pulmonary complications in patients with esophageal cancer who were treated preoperatively with chemotherapy and irradiation. The Hamburg Esophageal Study Group is currently undertaking a prospective randomized study to evaluate the efficacy of preoperative treatment. Postoperative pulmonary complications and mortality in these patients with either a combined preoperative treatment (group 1, n = 11) or chemotherapy alone (group 2, n = 9) are evaluated in the present paper. Complete remission of the tumor was found more often in group 1 (54.6%) than in group 2 (22.2%). However, postoperatively the patients of group 1 developed adult respiratory distress syndrome (ARDS; 54.6%) more frequently than in group 2 (11.1%), and all patients with ARDS died. Thus, although the combined preoperative treatment is more effective in tumor remission, it is associated with a higher respiratory failure and postoperative mortality. Therefore, the preoperative regime has now been changed by the study group. Since after the clinical manifestation of ARDS no causative clinical therapy is available up to now, attention must be focused on the prevention of respiratory failure.

Impact of Induction Concurrent Chemoradiotherapy on Pulmonary Function and Postoperative Acute Respiratory Complications in Esophageal Cancer

“…Because of the limited success achieved with surgical resection for these patients, multimodality treatment regimens using preoperative chemotherapy, either with or without radiation, have evolved in an effort to reduce the size of the primary tumor, increase local tumor control, decrease distal recurrences, and improve overall survival. [5][6][7][8] Randomized trials 2,3,9 -11 of preoperative chemotherapy or concurrent chemoradiotherapy (cCRT) have been completed but have produced inconclusive or contradictory results. In addition, although preoperative chemotherapy alone appears to be well tolerated, preoperative chemoradiotherapy has been associated with perioperative morbidity as high as 57%, and a perioperative mortality of up to 30%.…”

Impairment of Lung Function Increases the Risk of Postoperative Respiratory Failure for Esophageal Carcinoma: A Systematic Review and Meta-Analysis

“…(2) documents with repeated reports; (3) articles with poor research design and substandard quality; (4) studies with incomplete data required; (5) reviews and systematic evaluative literature; (6) literature with few subjects included; and (7) studies without a control group [9][10][11].…”

Effusion cytology of esophageal carcinoma

“…Recently, multimodality therapy including radiation, chemotherapy, and surgery has become increasingly popular for these patients. Patients undergoing these procedures may develop an effusion, although it often is benign 19, 20. Perhaps as a result of this changing pattern of therapy, we have noticed in our cytology laboratory a large number of effusions in patients diagnosed with esophageal carcinoma, some of which have contained malignant cells.…”