Pham Binh Van, Nguyen Duy Duc, Thai An Duc, Tran Manh Dai, Nguyen Thanh Duy, Nguyen Binh Tien
Department of Abdominal Surgery 1, Vietnam National Cancer Hospital, Hanoi, Vietnam.
Center of Robotic Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam.
Ann Med Surg (Lond). 2025 Jul 14;87(9):5417-5421. doi: 10.1097/MS9.0000000000003566. eCollection 2025 Sep.
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).
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.
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.
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.
食管手术后的并发症很严重，其中呼吸并发症最为常见。本研究旨在评估食管鳞状细胞癌（ESCC）食管切除及淋巴结清扫术后呼吸并发症的发生率及相关因素。
2022年10月至2024年3月对接受微创食管切除术及扩大两野淋巴结清扫术的ESCC患者进行了一项前瞻性横断面研究。
观察到18例（25.7%）发生肺炎，其中15例记录为Clavien-Dindo二级，2例为三级，1例为四级。术后120天内无死亡病例。显著影响呼吸并发症的因素包括喉返神经（RLN）麻痹（P = 0.02）、肺龄（P = 0.04）、肺龄与实际年龄（L-R）差值-L-R（P = 0.03）、第一秒用力呼气容积（FEV1）（P = 0.045）以及阻塞性/限制性肺病（P = 0.015）。发生呼吸并发症的患者组平均重症监护病房停留时间和住院时间更长（分别为P = 0.000和P = 0.001）。肺龄和L-R差值比FEV1、FEV1%和蒂芬诺指数更能预测呼吸并发症（P < 0.05，曲线下面积>0.5）。L-R差值≥23.7岁和肺龄≥76.4岁的阈值被确定为有预测性。
食管癌手术后呼吸并发症很常见，发生率为25.7%。影响呼吸并发症发生率的因素包括RLN麻痹、肺龄、L-R差值、FEV1以及阻塞性/限制性肺病。肺龄和L-R差值比FEV1、FEV1%和蒂芬诺指数更能预测呼吸并发症。
