Impact of chronic obstructive pulmonary disease on postoperative complications and short-term prognosis in patients undergoing oesophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LEI Kai , FENG Tianci , ZHAO Zheng ,  WANG Xiaowen ,  HUANG Chun , WU Qingchen

Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding author：

WANG Xiaowen, Email: xiaowenwang@yeah.net; HUANG Chun, Email: hcsurgery@163.com

Keywords：

Chronic obstructive pulmonary disease; esophageal neoplasms; postoperative complications; survival analysis; surgery

DOI：

10.7507/1007-4848.202009042

Video：

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Objective To provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.Methods The clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.Results The incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1% vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate.Conclusion COPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.

Citation： LEI Kai, FENG Tianci, ZHAO Zheng, WANG Xiaowen, HUANG Chun, WU Qingchen. Impact of chronic obstructive pulmonary disease on postoperative complications and short-term prognosis in patients undergoing oesophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 200-205. doi: 10.7507/1007-4848.202009042 Copy

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11.	崔玉尚, 张志庸, 阿伊都·阿布都热伊木. 开胸术后早期肺功能的变化规律及影响因素分析. 中华外科杂志, 2003, 41(12): 909-912.
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14.	Ma G, Zhang X, Ma Q, et al. A novel multivariate scoring system for determining the prognosis of lymph node-negative esophageal squamous cell carcinoma following surgical therapy: An observational study. Eur J Surg Oncol, 2015, 41(4): 541-547.
15.	Markar S, Gronnier C, Duhamel A, et al. Pattern of postoperative mortality after esophageal cancer resection according to center volume: Results from a large european multicenter study. Ann Surg Oncol, 2015, 22(8): 2615-2623.
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17.	刘现海, 李峰, 路宏燕, 等. 肺功能指标对食管癌患者术后肺部感染的预测价值. 中华医院感染学杂志, 2019, 29(9): 1379-1383.
18.	于善海, 李德生, 伊力亚尔·夏合丁, 等. 食管癌切除术后并发症多因素 Logistic 回归分析及风险模型建立. 世界华人消化杂志, 2011, 19(34): 3508-3513.
19.	陈晓珍, 张怀忠, 方韬. 食管癌术后并发症危险因素的 Logistic 分析及护理干预. 中国药物与临床, 2014, 14(3): 300-302.
20.	Ohi M, Toiyama Y, Omura Y, et al. Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer. Surg Today, 2019, 49(2): 176-186.
21.	田烨, 周凌霄, 任光国. 1208 例食管癌患者术后吻合口瘘风险因素分析. 重庆医学, 2014, 43(15): 1924-1927.
22.	沈伟忠, 黄建峰. 食管癌术后心律失常危险因素分析. 中国肿瘤外科杂志, 2015, 7(6): 384-386.
23.	杨泽山. 431 例老年食管癌患者术后肺部并发症情况及危险因素分析. 中华全科医学, 2015, 13(11): 1779-1781, 1868.
24.	杨立新, 梁伟, 于婵娟, 等. 胸腹腔镜联合食管癌根治术后肺部并发症的危险因素分析. 临床外科杂志, 2017, 25(7): 512-515.
25.	许冰. 食管癌、贲门癌术后心律失常的原因分析. 肿瘤基础与临床, 2012, 25(1): 40-42.
26.	郝栋, 刘国魁, 邱新民. 低肺功能食管癌高龄患者的围术期治疗探讨. 白求恩军医学院学报, 2009, 7(4): 219-220.
27.	沙纪名, 林泽邦, 徐盛松, 等. 临界肺功能食管癌患者微创手术的临床疗效研究. 安徽医学, 2019, 40(8): 917-920.
28.	Noguchi T, Shichinohe T, Hirano S, et al. Minimally invasive esophagectomy for cancer patients with low pulmonary function. Hepatogastroenterology, 2010, 57(101): 768-771.

1. WHO. Global burden of disease website. [2020-10-15]. http:/www.who.int/topics/global_burden of disease.
2. GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. [2020-08-09]. https://goldcopd.org/gold-reports/.
3. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
4. 戴伟, 王小文, 黄春, 等. 肺癌切除术后心房颤动发生的危险因素及发病机制研究进展. 上海交通大学学报(医学版), 2018, 38(5): 573-577.
5. 王小文, 黄春, 葛明建, 等. 胸腔镜手术与传统开胸术后心律失常发生率的前瞻性对比研究. 中华胸心血管外科学杂志, 2013, 29(1): 4-7.
6. 陈伟, 冯天赐, 王小文, 等. 合并2型糖尿病的非小细胞肺癌患者肺切除术后近期预后的临床分析. 中国胸心血管外科临床杂志, 2020, 27(8): 912-917.
7. 孙芳艳, 钱培芬. 慢性阻塞性肺疾病综合肺康复方案的研究进展. 中华护理杂志, 2010, 45(8): 755-757.
8. Krzystek-Korpacka M, Matusiewicz M, Diakowska D, et al. Respiratory insufficiency related to COPD accelerates systemic inflammation, under-nutrition, and angiogenesis in esophageal malignancies. Exp Oncol, 2008, 30(1): 75-80.
9. Aggarwal BB, Shishodia S, Sandur SK, et al. Inflammation and cancer: how hot is the link? Biochem Pharmacol, 206, 72(11): 1605-1621.
10. Oudijk EJ, Lammers JW, Koenderman L. Systemic inflammation in chronic obstructive pulmonary disease. Eur Respir J Suppl, 2003, 46: 5s-13s.
11. 崔玉尚, 张志庸, 阿伊都·阿布都热伊木. 开胸术后早期肺功能的变化规律及影响因素分析. 中华外科杂志, 2003, 41(12): 909-912.
12. Kageyama S, Ikeda H, Miyahara Y, et al. Adoptive transfer of MAGE-A4 t-cell receptor gene-transduced lymphocytes in patients with recurrent esophageal cancer. Clin Cancer Res, 2015, 21(10): 2268-2277.
13. Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg, 2011, 91(5): 1494-1500.
14. Ma G, Zhang X, Ma Q, et al. A novel multivariate scoring system for determining the prognosis of lymph node-negative esophageal squamous cell carcinoma following surgical therapy: An observational study. Eur J Surg Oncol, 2015, 41(4): 541-547.
15. Markar S, Gronnier C, Duhamel A, et al. Pattern of postoperative mortality after esophageal cancer resection according to center volume: Results from a large european multicenter study. Ann Surg Oncol, 2015, 22(8): 2615-2623.
16. Yoshida R, Morita M, Shoji F, et al. Clinical significance of SIP1 and E-cadherin in patients with esophageal squamous cell carcinoma. Ann Surg Oncol, 2015, 22(8): 2608-2614.
17. 刘现海, 李峰, 路宏燕, 等. 肺功能指标对食管癌患者术后肺部感染的预测价值. 中华医院感染学杂志, 2019, 29(9): 1379-1383.
18. 于善海, 李德生, 伊力亚尔·夏合丁, 等. 食管癌切除术后并发症多因素 Logistic 回归分析及风险模型建立. 世界华人消化杂志, 2011, 19(34): 3508-3513.
19. 陈晓珍, 张怀忠, 方韬. 食管癌术后并发症危险因素的 Logistic 分析及护理干预. 中国药物与临床, 2014, 14(3): 300-302.
20. Ohi M, Toiyama Y, Omura Y, et al. Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer. Surg Today, 2019, 49(2): 176-186.
21. 田烨, 周凌霄, 任光国. 1208 例食管癌患者术后吻合口瘘风险因素分析. 重庆医学, 2014, 43(15): 1924-1927.
22. 沈伟忠, 黄建峰. 食管癌术后心律失常危险因素分析. 中国肿瘤外科杂志, 2015, 7(6): 384-386.
23. 杨泽山. 431 例老年食管癌患者术后肺部并发症情况及危险因素分析. 中华全科医学, 2015, 13(11): 1779-1781, 1868.
24. 杨立新, 梁伟, 于婵娟, 等. 胸腹腔镜联合食管癌根治术后肺部并发症的危险因素分析. 临床外科杂志, 2017, 25(7): 512-515.
25. 许冰. 食管癌、贲门癌术后心律失常的原因分析. 肿瘤基础与临床, 2012, 25(1): 40-42.
26. 郝栋, 刘国魁, 邱新民. 低肺功能食管癌高龄患者的围术期治疗探讨. 白求恩军医学院学报, 2009, 7(4): 219-220.
27. 沙纪名, 林泽邦, 徐盛松, 等. 临界肺功能食管癌患者微创手术的临床疗效研究. 安徽医学, 2019, 40(8): 917-920.
28. Noguchi T, Shichinohe T, Hirano S, et al. Minimally invasive esophagectomy for cancer patients with low pulmonary function. Hepatogastroenterology, 2010, 57(101): 768-771.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of chronic obstructive pulmonary disease on postoperative complications and short-term prognosis in patients undergoing oesophagectomy

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