caa a22 4500 445336749 CHVBK 20180317142758.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1245/s10434-010-1474-5 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1474-5 Factors Associated with Postoperative Pulmonary Morbidity After Esophagectomy for Cancer [Elektronische Daten] [Urs Zingg, Bernard Smithers, David Gotley, Garett Smith, Ahmad Aly, Anthony Clough, Adrian Esterman, Glyn Jamieson, David Watson] Background: Most studies analyzing risk factors for pulmonary morbidity date from the early 1990s. Changes in technology and treatment such as minimally invasive esophagectomy (MIE) and neoadjuvant treatment mandate analysis of more contemporary cohorts. Methods: Predictive factors for overall and specific pulmonary morbidity in 858 patients undergoing esophagectomy between 1998 and 2008 in five Australian university hospitals were analyzed by logistic regression models. Results: A total of 394 patients underwent open esophagectomy, and 464 patients underwent MIE. A total of 259 patients received neoadjuvant chemoradiotherapy, 139 preoperative chemotherapy alone, and 2 preoperative radiotherapy alone. In-hospital mortality was 3.5%. Smoking and the number of comorbidities were risk factors for overall pulmonary morbidity (odds ratio [OR] 1.47, P=0.016; OR 1.35, P=0.001) and pneumonia (OR 2.29, P=0.002; 1.56, P=0.005). The risk of respiratory failure was higher in patients with more comorbidities (OR 1.4, P=0.035). Respiratory comorbidities (OR 3.81, P=0.017) were strongly predictive of postoperative acute respiratory distress syndrome (ARDS). ARDS (4.51, P=0.032) or respiratory failure (OR 8.7, P<0.001), but not anastomotic leak (OR 2.22, P=0.074), were independent risk factors for death. MIE (OR 0.11, P<0.001) and thoracic epidural analgesia (OR 0.12, P=0.003) decreased the risk of respiratory failure. Neoadjuvant treatment was not associated with an increased risk of pulmonary complications. Conclusions: Preoperative comorbidity and smoking were risk factors for respiratory complications, whereas neoadjuvant treatment was not. MIE and the use of thoracic epidural analgesia decreased the risk of respiratory failure. Respiratory failure and ARDS were the only independent factors associated with an increased risk of in-hospital death, whereas anastomotic leakage was not. Society of Surgical Oncology, 2010 Zingg Urs Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia aut Smithers Bernard Department of General Surgery, Princess Alexandra Hospital, Brisbane, Australia aut Gotley David Department of General Surgery, Princess Alexandra Hospital, Brisbane, Australia aut Smith Garett Department of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia aut Aly Ahmad Department of Surgery, University of Melbourne, Melbourne, Australia aut Clough Anthony Department of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia aut Esterman Adrian School of Nursing and Midwifery, University of South Australia, Adelaide, Australia aut Jamieson Glyn Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia aut Watson David Department of Surgery, Flinders University, Bedford Park, Australia aut Annals of Surgical Oncology Springer-Verlag 18/5(2011-05-01), 1460-1468 1068-9265 18:5<1460 2011 18 10434 https://doi.org/10.1245/s10434-010-1474-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1474-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Zingg Urs Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia aut NATIONALLICENCE 700 1- Smithers Bernard Department of General Surgery, Princess Alexandra Hospital, Brisbane, Australia aut NATIONALLICENCE 700 1- Gotley David Department of General Surgery, Princess Alexandra Hospital, Brisbane, Australia aut NATIONALLICENCE 700 1- Smith Garett Department of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia aut NATIONALLICENCE 700 1- Aly Ahmad Department of Surgery, University of Melbourne, Melbourne, Australia aut NATIONALLICENCE 700 1- Clough Anthony Department of Surgery, Royal North Shore Hospital, University of Sydney, Sydney, Australia aut NATIONALLICENCE 700 1- Esterman Adrian School of Nursing and Midwifery, University of South Australia, Adelaide, Australia aut NATIONALLICENCE 700 1- Jamieson Glyn Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia aut NATIONALLICENCE 700 1- Watson David Department of Surgery, Flinders University, Bedford Park, Australia aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/5(2011-05-01), 1460-1468 1068-9265 18:5<1460 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer