Assessment of a predictive score for pulmonary complications in cancer patients after esophagectomy

doi:10.5847/wjem.j.1920-8642.2016.01.008

Abstract

Abstract:

BACKGROUND: Esophagectomy is a very important method for the treatment of resectable esophageal cancer, which carries a high rate of morbidity and mortality. This study was undertaken to assess the predictive score proposed by Ferguson et al for pulmonary complications after esophagectomy for patients with cancer.
METHODS: The data of patients who admitted to the intensive care unit after transthoracic esophagectomy at Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College between September 2008 and October 2010 were retrospectively reviewed.
RESULTS: Two hundred and seventeen patients were analyzed and 129 (59.4%) of them had postoperative pulmonary complications. Risk scores varied from 0 to 12 in all patients. The risk scores of patients with postoperative pulmonary complications were higher than those of patients without postoperative pulmonary complications (7.27±2.50 vs. 6.82±2.67; P=0.203). There was no significant difference in the incidence of postoperative pulmonary complications as well as in the increase of risk scores (χ ²=5.477, P=0.242). The area under the curve of predictive score was 0.539±0.040 (95%CI 0.461 to 0.618; P=0.324) in predicting the risk of pulmonary complications in patients after esophagectomy.
CONCLUSION: In this study, the predictive power of the risk score proposed by Ferguson et al was poor in discriminating whether there were postoperative pulmonary complications after esophagectomy for cancer patients.

Key words: Respiratory insufficiencty, Esophagectomy, Predictive

Xue-zhong Xing, Yong Gao, Hai-jun Wang, Shi-ning Qu, Chu-lin Huang, Hao Zhang, Hao Wang, Quan-hui Yang. Assessment of a predictive score for pulmonary complications in cancer patients after esophagectomy[J]. World Journal of Emergency Medicine, 2016, 7(1): 44-49.

Figures/Tables 6

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Variables	Pulmonary complications		t/χ²	P
Variables	No (n=88)	Yes (n=129)	t/χ²	P
Age (years)	65.05±9.71	64.27±9.38	0.589	0.557
Male, n (%)	105 (85.4)	77 (81.9)	0.469	0.493
BMI (kg/m²)	24.00±3.78	23.75±3.95	0.463	0.644
Current cigarette use, n (%)	56 (63.6)	79 (61.2)	0.128	0.721
Alcohol use, n (%)	50 (56.8)	59 (45.7)	2.570	0.109
Hypertension, n (%)	41 (46.6)	45 (34.9)	2.997	0.083
Coronary artery disease, n (%)	9 (10.2)	16 (12.5)	0.263	0.608
Diabetes mellitus, n (%)	13 (14.8)	13 (9.3)	1.536	0.215
COPD, n (%)	2 (2.3)	2 (1.6)	0.151	0.698
Performance status	0.58±0.52	0.58±0.50	-0.026	0.979
Hemoglobin (g/dL)	13.97±1.78	13.47±2.18	1.751	0.081
Albumin (g/L)	41.53±5.10	40.54±4.40	1.515	0.131
FEV₁ (L)	2.33±0.67	2.29±0.62	0.472	0.638
FEV₁%	78.87±9.80	76.53±10.69	1.590	0.113
D_LCO%	79.41±18.51	76.90±18.02	0.914	0.362
Risk scores	6.82±2.67	7.27±2.50	-1.276	0.203

Variables	Pulmonary complications		t/χ²	P
Variables	No (n=88)	Yes (n=129)	t/χ²	P
Surgical approach, n (%)			1.749	0.417
Left transthoracic	70 (79.5)	94 (72.9)
Ivor-Lewis approach	8 (9.1)	12 (9.3)
Mckeown	10 (11.4)	23 (17.8)
Histology, n (%)			0.922	0.631
Adenocarcinoma	21(23.9)	29 (22.5)
Squamous cell	66 (75.0)	96 (74.4)
Others	1 (1.1)	4 (3.1)
Pathological stage, n (%)			2.351	0.671
Tis	0 (0)	1 (0.8)
I	9 (10.2)	11 (8.5)
II	30 (34.1)	44 (34.1)
III	48 (54.5)	73 (56.6)
IV	1 (1.1)	0 (0)
Intraoperative transfusion (mL)	307±523	425±763	-1.262	0.208
Anastomotic leak, n (%)
Cervical leak	4 (4.5)	8 (6.2)	0.275	0.600
Intrathoracic leak	3 (3.4)	24 (18.6)	11.088	0.001
Length of operation (minute)	244±79	247±84	-0.203	0.839
ICU mortality, n (%)	0 (0)	4 (3.1)	2.780	0.095
Operative mortality, n (%)	2 (2.3)	11 (8.5)	3.634	0.057

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