Impact of the combined thoracoscopic and laparoscopic surgery for patients with esophageal cancer on pulmonary morbidity after esophagectomy: A retrospective multivariate analysis

Naoshi Kubo, Masaichi Ohira, Katsunobu Sakurai, Hisashi Nagahara, Hiroaki Tanaka, Kazuya Muguruma, Kosei Hirakawa

Department of Surgical Oncology, Graduate school of medicine, Osaka-City University

Aim:
Esophagectomy for esophageal cancer has been considered to be associated with high rate of postoperative morbidity. Among various morbidities after esophagectomy, pulmonary complication (PC) has been reported to lead to prolonged hospital stay and the main cause of hospital mortality. Recently minimally invasive esophagectomy (MIE) has been reported to be associated to be lower rate of PC in comparison with conventional open surgery. Hence we retrospectively evaluated the predictive risk factors for PC after esophagectomy on open or minimally invasive manner by the multivariate regression analysis.

Patients and methods:
We conducted retrospective review analysis of predictive factors of postoperative pulmonary complication for 334 consecutive intrathoracic esophageal cancer patients underwent esophagectomy at the Department of Surgical Oncology, Osaka City University Hospital between April 2000 and April 2012. Various clinicopathological risk factors for PC after esophagectomy were evaluated.

Results:
In univariate analysis, open thoracotomy (versus Video Assisted Thoracoscopic Surgery;VATS), open laparotomy (versus Hand Assisted Laparoscopic Surgery:HALS), totally MIS (VATS and HALS) (versus hybrid MIS or totally open procedure) frequently developed PC. In multivariate analysis, advanced age (OR 6.741, 95% CI 2.366-19.205, p=0.0001 ), lower level of albumin (OR 2.64, 95%CI 1.053-6.620, p=0.038), longer duration of operative time (OR 2.27. 95%C.I. 1.115-4.651, P=0.024), anastomotic leakage (OR 4.203, 95% CI 1.624-10.878, p=0.003) and chyle leakage (OR 2.961. 95% CI 1.135-7.725, p=0.027) were independent risk factors for PC after esophagectomy. Inversely totally MIS (VATS and HALS) significantly decreased the risk for PC (OR 0.286, 95% CI 0.107-0.762, P=0.012) while hybrid MIS was not.

Conclusion:
Totally MIE was an excellent surgical procedure for patients with resectable esophageal cancer at the point of view for postoperative pulmonary complication.


Session: Poster Presentation

Program Number: P608

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