Pulmonary complications after esophagectomy

Avendano, Christopher E.; Flume, Patrick A.; Silvestri, Gerard A.; King, Lydia; Reed, Carolyn E.

doi:10.1016/s0003-4975(01)03584-6

Cited by 257 publications

(192 citation statements)

References 29 publications

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“…Whether preoperative chemoradiotherapy is responsible for a higher pulmonary complication rate cannot be excluded. In a retrospective study of Avendano et al (2002) preoperative chemoradiotherapy was associated with an increase risk of pulmonary complications (i.e., duration of mechanical ventilation). Whether the decline in pulmonary function tests (TLC, VC, and FEV1) that we observed in our study was due to the chemoradiotherapy is uncertain, as it has also been reported that the TLC and the VC were significantly reduced after an oesophagectomy without preoperative treatment (Crozier et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

et al. 2006

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This study was performed to assess the efficacy and safety of preoperative chemoradiation consisting of carboplatin and paclitaxel and concurrent radiotherapy for patients with resectable (T2-3N0-1M0) oesophageal cancer. Treatment consisted of paclitaxel 50 mg m À2 and carboplatin AUC ¼ 2 on days 1, 8, 15, 22 and 29 and concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week), followed by oesophagectomy. All 54 entered patients completed the chemoradiation without delay or dose-reduction. Grade 3 -4 toxicities were: neutropaenia 15%, thrombocytopaenia 2%, and oesophagitis 7.5%. After completion of the chemoradiotherapy 63% had a major endoscopical response. Fifty-two patients (96%) underwent a resection. The postoperative mortality rate was 7.7%. All patients had an R0-resection. The pathological complete response rate was 25%, and an additional 36.5% had less than 10% vital residual tumour cells. At a median follow-up of 23.2 months, the median survival time has not yet been reached. The probability of disease-free survival after 30 months was 60%. In conclusion, weekly neoadjuvant paclitaxel and carboplatin with concurrent radiotherapy is a very tolerable regimen and can be given on an outpatient basis. It achieves considerable down staging and a subsequent 100% radical resection rate in this series. A phase III trial with this regimen is now ongoing.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

et al. 2006

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“…Among the postoperative complications after thoracoabdominal esophagectomy, pulmonary complications as well as anastomotic leakage tend to be the most critical (15,16). For instance, up to 30% of the patients after thoracoabdominal esophagectomy develop pulmonary complications such as ALI or even ARDS (17).…”

Section: Introductionmentioning

confidence: 99%

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Frick

Justinger²,

Rubie³

et al. 2011

Oncol Rep

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Abstract. Pulmonary complications together with surgical complications are the most frequent causes for morbidity and mortality after thoracoabdominal esophagectomy. The con tinuous improvement of surgical techniques has led to a decrease in surgical complications, whereas up to 30% of the patients develop postoperative pulmonary complications such as acute lung injury (ALI) or even the more severe acute respiratory distress syndrome (ARDS), which are characterized by an acute inflammation in the lung parenchyma and the airspace. Evidence from several studies indicates that a complex network of inflammatory cytokines and mediators play a key role in mediation, amplification, and perpetuation of the process of lung injury and that the thoracotomy itself is a risk factor for developing ALI or ARDS. In this trial, the cytokine levels of IL6, IL8 and IL10 were measured and compared in 30 patients who had undergone an extended radical thoracoabdominal esophagectomy for esophageal cancer, via anterolateral thoracotomy (n=17) or posterolateral thoracotomy (n=13). Patients of both groups were similar in terms of age, sex and preoperative pulmonary function as well as in the anesthetic procedures they have undergone. All patients displayed significantly increased serum levels of IL6 and IL8 after thoracoabdominal esophagectomy. However, patients who were subjected to an anterolateral thoracotomy were reported with significantly higher serum levels of IL6 and IL8 compared to patients who had received a posterolateral thoracotomy. Thus, the choice of the thoracotomy method during the thoracoabdominal esophagectomy and the resultant cytokine levels may contribute to the occurrence of postoperative pulmonary complications and may have an impact on the extent and severity of the surgical stress.

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“…O atendimento de fisioterapia respiratória na enfermaria não foi protocolado, mas orientado pelo mesmo profissional fisioterapeuta durante todo o período avaliado e foi aplicado com base nas condições clínicas dos aquelas verificadas na esofagectomia, que é a cirurgia com maior morbimortalidade respiratória 4,13 . Numa análise detalhada das revisões sistemáticas sobre a efetividade da fisioterapia nas complicações pós-operatórias abdominais altas, os autores 17 constataram que não foi analisado um único caso de esofagectomia, portanto não se conhecem estudos que avaliaram os efeitos da fisioterapia respiratória nas complicações dessa cirurgia.…”

Section: Dados Dos Procedimentos Cirúrgicosunclassified

“…A taxa de incidência dessas complicações encontradas no presente estudo variou de 5 a 30%, sendo menor do que as taxas descritas na literatura, que variam entre 17 e 88% 12,[23][24][25] . Alguns estudos sugerem que certos fatores predispõem à incidência de complicações pós-cirúrgicas, tais como idade superior a 65 anos, função pulmonar deteriorada, presença de malignidade, sítio cirúrgico, desnutrição e desempenho físico e psicossocial 4,11,14,17,26,27 . Analisando alguns desses fatores no presente estudo, verificou-se que, apesar de não haver diferença estatística entre os grupos, o gALTA apresentou maior número de idosos e de pacientes com história tabágica do que o gUTI e, mesmo assim, apresentou significante menor incidência de CPO.…”

Section: Discussão E Conclusãounclassified

“…Além disso, se realizada de maneira profilática, a fisioterapia respiratória também parece reduzir a incidência de pneumonia em pacientes de alto risco submetidos a cirurgias abdominais altas 17 . Vários estudos avaliam o efeito da fisioterapia respiratória em pacientes submetidos a cirurgias abdominais, mas esses estudos não discriminam as cirurgias segundo o porte 18,19 , e não há como comparar as complicações pós-operatórias de uma colecistectomia ou de uma correção de hérnia inguinal com peso, altura, índice de massa corpórea (IMC, calculado pelo produto do peso, em quilogramas, dividido pela altura em metros ao quadrado), dados clíni-cos, diagnóstico, hábitos e vícios (tabagismo e etilismo).…”

Section: Introductionunclassified

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Efeito da continuidade da fisioterapia respiratória até a alta hospitalar na incidência de complicações pulmonares após esofagectomia por câncer

Lunardi¹,

Resende²,

Cerri³

et al. 2008

Fisioter. Pesqui.

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ACEITO PARA PUBLICAÇÃO fev. 2008RESUMO: O presente estudo avaliou os efeitos na incidência de complicações pulmonares do cuidado contínuo de fisioterapia respiratória no pós-operatório de esofagectomia, até a alta hospitalar. Examinaram-se retrospectivamente 40 prontuários de pacientes de esofagectomia consecutivos (nenhuma exclusão), que foram divididos em dois grupos: um dos que receberam fisioterapia respiratória apenas na unidade de tratamento intensivo (gUTI, n=20) e outro dos que a receberam até a alta hospitalar (gALTA, n=20). Foram coletadas informações referentes ao pré, intra e pós-operatório. Os resultados mostram que gUTI e gALTA, respectivamente, apresentaram-se similares (média±dp) quanto a idade (55,5±9,9 e 57,1±10,8 anos), IMC (22,5±3,3 e 18±4 kg/m 2 ), tempo de cirurgia (400±103,8 e 408,5±142 min), tempo de anestesia (498,3±107,3 e 516±148,9 min) e número de atendimentos de fisioterapia na UTI (9,6±14,9 e 8,3±7,6). Apesar de o gALTA apresentar história de tabagismo superior (35,7±17,6 vs 26,1±18,4 maços-ano, p<0,05), houve menos 20% de complicações respiratórias após esofagectomia nesse grupo quando comparado ao gUTI (10% vs 30%, p<0,05): incidência 75% menor de derrame pleural e 50% menos broncopneumonia. Além disso, o gALTA teve permanência menor de dreno pleural no hemitórax direito (menos 4,5 dias, p<0,05). Estes achados sugerem que os cuidados de fisioterapia respiratória até a alta hospitalar podem reduzir a incidência de complicações pulmonares após esofagectomia por câncer. DESCRITORES:Cuidados pós-operatórios; Esofagectomia/complicações; Esofagectomia/ reabilitação; Fisioterapia (respiratória)ABSTRACT: This study assessed the effects of chest physical therapy all through hospital stay until discharge onto the incidence of pulmonary complications in patients having undergone esophagectomy for cancer. Medical records of esophagectomy patients were examined and 40 subsequent ones selected (none excluded), and divided into two groups: one having received chest physiotherapy only in the intensive care unit (ICUg, n=20) and the other having received it during full hospital stay (DISg, n=20). Information concerning pre-, peri-and postoperative periods were drawn from patients' records. Results show that ICUg and DISg were similar (mean±sd) concerning age (55.5±9.9 vs 57.1±10.8 years old), BMI (22.5±3.3 vs 18±4 kg/m 2 ), operating time (400±103.8 vs 408.5±142 min), anesthesia time (498.3±107.3 vs 516±148.9 min) and number of chest physical therapy sessions in the ICU (9.6±14.9 vs 8.3±7.6 sessions). Despite the fact that DISg patients had higher tobacco consumption than ICUg ones (35.7±17.6 vs 26.1±18.4 packs-year, p<0.05), there were 20% less pulmonary complications in this group when compared to the ICU group (10% vs 30%, p<0.05): lesser incidence (75%) of pleural effusion and 50% less of bronchopneumonia. DISg also had undergone a shorter time (less 4.5 days) with pleural drain on (p<0.05). These findings suggest chest physical therapy care all along hospital stay until discharge may redu...

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Pulmonary complications after esophagectomy

Cited by 257 publications

References 29 publications

Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Efeito da continuidade da fisioterapia respiratória até a alta hospitalar na incidência de complicações pulmonares após esofagectomia por câncer

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