Respiratory complications following minimally invasive esophagectomy: associated factors and predictive value of lung age.

BACKGROUND

Postoperative complications following esophageal surgery are severe, with respiratory complications being the most common. This study aims to evaluate the rate of respiratory complications and related factors post-esophagectomy and lymph node dissection for esophageal squamous cell carcinoma (ESCC).

SUBJECTS AND METHODS

A prospective cross-sectional study was conducted from October 2022 to March 2024 on ESCC who underwent minimally invasive esophagectomy and extended two-field lymph node dissection.

RESULTS

Pneumonia was observed in 18 cases (25.7%), with 15 cases recorded as Clavien-Dindo grade II, 2 cases as grade III, and 1 case as grade IV. There were no deaths within 120 days postoperative. Factors significantly affected the respiratory complications, including recurrent laryngeal nerve (RLN) palsy ( = 0.02), lung age ( = 0.04), lung-age and real-age (L-R) difference-L-R ( = 0.03), FEV1 ( = 0.045), and the obstructive/restrictive lung disease ( = 0.015). The average intensive care unit stay and hospital stay were longer in the group with respiratory complications ( = 0.000 and = 0.001, respectively). Lung age and the L-R difference were more predictive of respiratory complications than FEV1, FEV1%, and Tiffeneau index ( < 0.05, AUC > 0.5). Thresholds of ≥23.7 years for L-R difference and ≥76.4 years for lung age were identified as predictive.

CONCLUSION

Respiratory complications are common following esophageal cancer surgery, with a rate of 25.7%. Factors affecting the incidence of respiratory complications include RLN palsy, pulmonary age, L-R difference, FEV1, and the obstructive/restrictive lung disease. Lung age and the L-R difference were more predictive of respiratory complications than FEV1, FEV1%, and Tiffeneau index.