Shiozaki Atsushi, Fujiwara Hitoshi, Okamura Hiroko, Murayama Yasutoshi, Komatsu Shuhei, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Ichikawa Daisuke, Okamoto Kazuma, Ochiai Toshiya, Kokuba Yukihito, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
Oncol Lett. 2012 Apr 1;3(4):907-912. doi: 10.3892/ol.2012.589. Epub 2012 Feb 1.
The development of surgical and postoperative management techniques has improved the treatment outcomes of esophageal cancer resection. However, respiratory morbidity is still the most frequent complication after esophagectomy. The objective of the present study was to identify risk factors for respiratory complications following resection for esophageal cancer. This study included 96 patients with esophageal cancer who had undergone esophagectomy with lymph node dissection. The patients were divided into 2 groups according to the presence (20 patients, 17 had pneumonia and 3 had acute respiratory distress syndrome) or absence (76 patients) of postoperative respiratory complications (PRC). The two groups were compared with respect to their preoperative clinical variables, such as age, body mass index, smoking history, serum albumin, serum C-reactive protein (CRP), number of lymphocytes, %VC, FEV1.0% and FEV1.0. Furthermore, multiple logistic regression analyses were used to estimate relative risk factors for respiratory complications. Results of the univariate analysis showed that smoking history (+/-, patients with PRC, 19/1 and without PRC, 53/23), serum CRP (≥1.0 mg/dl/<1.0 mg/dl, patients with PRC, 6/14 and without PRC, 6/70) and FEV1.0% (≥60%/<60%, patients with PRC, 16/4 and without PRC, 73/3) were significantly different between the two groups. Multiple logistic regression analysis showed that FEV1.0% was the strongest predictor of PRC. FEV1.0%, serum CRP and smoking history are reliable predictors of the risk of respiratory complications following esophageal cancer resection. For patients with these factors, perioperative management for the prevention of postoperative respiratory complications should be considered.
手术及术后管理技术的发展改善了食管癌切除的治疗效果。然而，呼吸并发症仍是食管切除术后最常见的并发症。本研究的目的是确定食管癌切除术后呼吸并发症的危险因素。本研究纳入了96例行食管癌切除并淋巴结清扫术的患者。根据术后呼吸并发症（PRC）的有无将患者分为两组（有PRC组20例，其中17例发生肺炎，3例发生急性呼吸窘迫综合征；无PRC组76例）。比较两组患者术前的临床变量，如年龄、体重指数、吸烟史、血清白蛋白、血清C反应蛋白（CRP）、淋巴细胞计数、%VC、FEV1.0%和FEV1.0。此外，采用多因素logistic回归分析评估呼吸并发症的相关危险因素。单因素分析结果显示，两组患者的吸烟史（有/无PRC，有PRC组19/1，无PRC组53/23）、血清CRP（≥1.0 mg/dl/<1.0 mg/dl，有PRC组6/14，无PRC组6/70）和FEV1.0%（≥60%/<60%，有PRC组16/4，无PRC组73/3）存在显著差异。多因素logistic回归分析显示，FEV1.0%是PRC最强有力的预测指标。FEV1.0%、血清CRP和吸烟史是食管癌切除术后呼吸并发症风险的可靠预测指标。对于存在这些因素的患者，应考虑围手术期管理以预防术后呼吸并发症。
