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Ann Thorac Surg 2002;73:922-926
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Pulmonary complications after esophagectomy

Christopher E. Avendano, MDa, Patrick A. Flume, MD*a, Gerard A. Silvestri, MDa, Lydia B. King, MPHb, Carolyn E. Reed, MDc

a Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
b Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, South Carolina, USA
c Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA

Accepted for publication November 20, 2001.

* Address reprint requests to Dr Flume, Medical University of South Carolina, 812-CSB, 96 Jonathan Lucas St, Charleston, SC 29425 USA
e-mail: flumepa{at}musc.edu

Background. Pulmonary complications are common in patients who have undergone esophagectomy. There are no good predictive variables for these complications. In addition, the role that preoperative treatment with chemotherapy and radiation may play in postoperative complications remains unclear.

Methods. We performed a retrospective review of all patients who underwent esophagectomy by a single surgeon at our institution over a 6-year period. Data were analyzed for a correlation between patient risk factors and pulmonary complications, including mortality, prolonged mechanical ventilation, and hospital length of stay.

Results. Complete data were available on 61 patients. Nearly all patients had some pulmonary abnormality (eg, pleural effusion), although most of these were clinically insignificant. Pneumonia was the most common clinically important complication, and 19.7% of patients required prolonged ventilatory support. Significant risk factors identified included impaired pulmonary function, especially for patients with forced expiratory volume in 1 second (FEV1) less than 65% of predicted, preoperative chemoradiotherapy, and age.

Conclusions. Impaired lung function is a significant risk factor for pulmonary complications after esophagectomy. Patients with FEV1 less than 65% of predicted appear to be at greatest risk. There also seems to be an associated risk of preoperative chemoradiotherapy for pulmonary complications after esophagectomy.




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