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

Figure 1.

Table 1

Table 2

Figure 2.

Figure 3.

Figure 4.

References 23

1	Mamidanna R, Bottle A, Aylin P, Faiz O, Hanna GB. Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study. Ann Surg 2012; 255:197-203. pmid: 22173202
2	Wright CD, Kucharczuk JC, O'Brien SM, Grab JD, Allen MS; Society of Thoracic Surgeons General Thoracic Surgery Database. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a society of thoracic surgeons general thoracic surgery database risk adjustment model. J Thorac Cardiovasc Surg 2009; 137:587-596. pmid: 19258071
3	Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg 2011; 91:1494-1501. pmid: 21524462
4	Xing XZ, Gao Y, Wang HJ, Yang QH, Huang CL, Qu SN, et al. Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency. World J Emerg Med 2013; 4:43-47. pmid: 25215091
5	Yoshida N, Watanabe M, Baba Y, Iwagami S, Ishimoto T, Iwatsuki M, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today 2014; 44:526-532.
6	Molena D, Mungo B, Stem M, Feinberg RL, Lidor AO. Outcomes of esophagectomy for esophageal achalasia in the United States. J Gastrointest Surg 2014; 18:310-317. pmid: 23963868
7	Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol 2004; 88:71-77. pmid: 15499604
8	Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 2004; 240:791-800. pmid: 15492560
9	Reinersman JM, Allen MS, Deschamps C, Ferguson MK, Nichols FC, Shen KR, et al. External validation of the Ferguson pulmonary risk score for predicting major pulmonary complications after oesophagectomy. Eur J Cardiothorac Surg 2015 Feb 26.pii: ezv021. [Epub ahead of print]
10	Mu J, Gao S, Mao Y, Xue Q, Yuan Z, Li N, et al. Open three-stage transthoracic oesophagectomy versus minimally invasive thoraco-laparoscopic oesophagectomy for oesophageal cancer: protocol for a multicentre prospective, open and parallel, randomised controlled trial. BMJ Open 2015; 17;5:e008328.
11	Mu J, Yuan Z, Zhang B, Li N, Lyu F, Mao Y, et al. Comparative study of minimally invasive versus open esophagectomy for esophageal cancer in a single cancer center. Chin Med J (Engl) 2014; 127:747-752.
12	Xing X, Gao Y, Wang H, Qu S, Huang C, Zhang H, et al. Correlation of fluid balance and postoperative pulmonary complications in patients after esophagectomy for cancer. J Thorac Dis 2015; 7:1986-93.
13	Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006; 354:2564-2575. pmid: 16714767
14	Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36:309-332. doi: 10.1016/j.ajic.2008.10.001
15	Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol 2010; 17:1721-1724. pmid: 20369299
16	Zingg U, Smithers BM, Gotley DC, Smith G, Aly A, Clough A, et al. Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol 2011; 18:1460-1468. pmid: 21184193
17	Masoomi H, Nguyen B, Smith BR, Stamos MJ, Nguyen NT. Predictive factors of acute respiratory failure in esophagectomy for esophageal malignancy. Am Surg 2012; 78:1024-1028. pmid: 23025932
18	Ruol A, Portale G, Zaninotto G, Cagol M, Cavallin F, Castoro C, et al. Results of esophagectomy for esophageal cancer in elderly patients: age has little influence on outcome and survival. J Thorac Cardiovasc Surg 2007; 133:1186-1192. pmid: 17467427
19	Avendano CE, Flume PA, Silvestri GA, King LB, Reed CE. Pulmonary complications after esophagectomy. Ann Thorac Surg 2002; 73:922-926. pmid: 11899202
20	Shiozaki A, Fujiwara H, Okamura H, Murayama Y, Komatsu S, Kuriu Y, et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett 2012; 3:907-912. pmid: 22741016
21	Mao YS, Zhang DC, He J, Zhang RG, Cheng GY, Sun KL, et al. Postoperative respiratory failure in patients with cancer of esophagus and gastric cardia (Article in Chinese). Zhonghua Zhong Liu Za Zhi 2005; 27:753-756. pmid: 16483491
22	Tandon S, Batchelor A, Bullock R, Gascoigne A, Griffin M, Hayes N, et al. Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth 2001; 86:633-638. pmid: 11575337
23	Gronnier C, Tréchot B, Duhamel A, Mabrut JY, Bail JP, Carrere N, et al. Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study. Ann Surg 2014; 260: 764-770; discussion 770-771. pmid: 25379847

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