Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Mingxin ¹ ,  ZHOU Chunjiao ² , JI Xingchen ¹ , GAO Qian ¹ , LIN Lijun ² , CAI Bingqin ²

1. Guangzhou University of Chinese Medicine, Guangzhou, 510006, P. R. China;
2. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P. R. China;

Corresponding author：

ZHOU Chunjiao, Email: gzchunjiao@163.com

Keywords：

Esophageal cancer; pulmonary infection; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202106031

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the risk factors for postoperative pulmonary infection in patients with esophageal cancer. Methods CNKI, Wangfang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library were searched from inception to January 2021 to collect case-control studies, cohort studies and cross-sectional studies about risk factors for postoperative pulmonary infection in patients with esophageal cancer. Two researchers independently conducted literature screening, data extraction and quality assessment. RevMan 5.3 software and Stata 15.0 software were used for meta-analysis. Results A total of 20 articles were included, covering 5 409 patients of esophageal cancer. The quality score of included studies was 6-8 points. Meta-analysis results showed that age (MD=1.99, 95%CI 0.10 to 3.88, P=0.04), age≥60 years (OR=2.68, 95%CI 1.46 to 4.91, P=0.001), smoking history (OR=2.41, 95%CI 1.77 to 3.28, P<0.001), diabetes (OR=2.30, 95%CI 1.90 to 2.77, P<0.001), chronic obstructive pulmonary disease (OR=3.69, 95%CI 2.09 to 6.52, P<0.001), pulmonary disease (OR=2.22, 95%CI 1.16 to 4.26, P=0.02), thoracotomy (OR=1.77, 95%CI 1.32 to 2.37, P<0.001), operation time (MD=14.08, 95%CI 9.64 to 18.52, P<0.001), operation time>4 h (OR=3.09, 95%CI 1.46 to 6.55, P=0.003), single lung ventilation (OR=3.46, 95%CI 1.61 to 7.44, P=0.001), recurrent laryngeal nerve injury (OR=5.66, 95%CI 1.63 to 19.71, P=0.006), and no use of patient-controlled epidural analgesia (PCEA) (OR=2.81, 95%CI 1.71 to 4.61, P<0.001) were risk factors for postoperative pulmonary infection in patients with esophageal cancer. Conclusion The existing evidence shows that age, age≥60 years, smoking history, diabetes, chronic obstructive pulmonary disease, pulmonary disease, thoracotomy, operation time, operation time>4 h, single lung ventilation, recurrent laryngeal nerve injury, and no use of PCEA are risk factors for postoperative pulmonary infection in patients with esophageal cancer. Due to the limitation of the quantity and quality of included literature, the conclusion of this study still needs to be confirmed by more high-quality studies.

Citation： WANG Mingxin, ZHOU Chunjiao, JI Xingchen, GAO Qian, LIN Lijun, CAI Bingqin. Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1467-1474. doi: 10.7507/1007-4848.202106031 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	崔芳芳, 何贤英, 宇传华, 等. 1990-2016年中国人群食管癌疾病负担变化趋势及危险因素分析. 中国卫生统计, 2021, 38(1): 87-91, 95.
3.	Asaka S, Shimakawa T, Yamaguchi K, et al. Postoperative pneumonia after esophagectomy and systemic inflammatory response syndrome. Anticancer Res, 2019, 39(2): 979-985.
4.	于佳, 张静, 纪灏. 食管癌手术患者医院感染直接经济损失分析. 中国感染控制杂志, 2021, 20(5): 467-472.
5.	Tamagawa A, Aoyama T, Tamagawa H, et al. Influence of postoperative pneumonia on esophageal cancer survival and recurrence. Anticancer Res, 2019, 39(5): 2671-2678.
6.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7.	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8.	叶韶峰. 食管癌术后肺部感染的围手术期危险因素及预防. 肿瘤学杂志, 2008, 14(5): 392-393.
9.	林晓铭, 池闯, 刘瑜, 等. 食管癌术后并发肺部感染的高危因素调查分析. 中华医院感染学杂志, 2012, 22(9): 1811-1812.
10.	高杨, 李岩, 周海英, 等. 食管癌患者术后肺部感染的影响因素分析. 中华医院感染学杂志, 2014, 24(13): 3281-3282, 3285.
11.	周小伟, 万志渝, 殷君太, 等. 食管癌手术围术期肺部感染的高危因素分析及预防. 中国胸心血管外科临床杂志, 2014, 21(5): 649-653.
12.	王启文, 曲明江, 赵晖, 等. 老年食管癌患者术后肺部感染的手术影响因素. 中国老年学杂志, 2015, 35(13): 3647-3649.
13.	谢琴, 莫占端, 华润, 等. 老年食管癌患者术后肺部感染影响因素与预防干预研究. 中华医院感染学杂志, 2016, 26(2): 346-348.
14.	谭何易, 赖应龙. 食管癌术后并发肺部感染的相关因素. 中华实验和临床感染病杂志(电子版), 2016, 10(4): 467-472.
15.	田学涛, 黄吉利. 食管癌术后肺部感染的多因素Logistic回归分析. 临床肺科杂志, 2016, 21(11): 2080-2082, 2083.
16.	王亚群, 王玲. 食管癌患者术后肺部感染的围术期影响因素分析. 临床麻醉学杂志, 2017, 33(6): 550-553.
17.	毛承毅, 柏茂树, 明波, 等. 食管癌术后肺部感染的多因素分析. 现代肿瘤医学, 2017, 25(19): 3082-3085.
18.	姚源山, 沈海波, 黄鸿渤, 等. 高龄食管癌患者术后肺部感染的相关因素分析. 中华医院感染学杂志, 2018, 28(6): 887-889.
19.	柯杨, 罗东, 柯有力. 老年食管癌根治术后发生肺部感染临床危险因素分析. 现代消化及介入诊疗, 2018, 23(5): 606-609.
20.	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.
21.	陈峙霖, 范平明, 李京泰, 等. 食管癌根治术后肺部感染病原学特点及影响因素Logistic回归分析. 中华医院感染学杂志, 2019, 29(5): 710-713.
22.	党新臣, 钱河, 赵宝生. 食管癌患者术后肺部感染危险因素分析. 新乡医学院学报, 2020, 37(10): 950-954.
23.	Sakamoto K, Oka M, Yoshino S, et al. Relationship between cytokine gene polymorphisms and risk of postoperative pneumonia with esophageal cancer. J Gastrointest Surg, 2014, 18(7): 1247-1253.
24.	Wei R, Dong W, Shen H, et al. Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer. Sci Rep, 2016, 6: 23636.
25.	Goense L, van Rossum PS, Tromp M, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-10.
26.	Liu G, Peng L, Liu B, et al. Analysis of risk factors for pulmonary infection in patients with minimally invasive esophagectomy. Oncol Lett, 2019, 17(3): 3283-3288.
27.	Soutome S, Hasegawa T, Yamguchi T, et al. Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: A multicenter retrospective study of 775 patients. Support Care Cancer, 2020, 28(9): 4155-4162.
28.	Crotty Alexander LE, Shin S, Hwang JH. Inflammatory diseases of the lung induced by conventional cigarette smoke: A review. Chest, 2015, 148(5): 1307-1322.
29.	Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg, 2019, 43(2): 299-330.
30.	Klekotka RB, Mizgała E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
31.	雷凯, 冯天赐, 赵政, 等. 慢性阻塞性肺疾病对食管癌患者术后近期预后的影响. 中国胸心血管外科临床杂志, 2022, 29(2): 200-205.
32.	Pu S, Chen H, Zhou C, et al. Major Postoperative complications in esophageal cancer after minimally invasive esophagectomy compared with open esophagectomy: An updated meta-analysis. J Surg Res, 2021, 257: 554-571.
33.	Li P, Gu L, Bian Q, et al. Effects of prostaglandin E 1 nebulization of ventilated lung under 60% O₂ one lung ventilation on patients' oxygenation and oxidative stress: A randomised controlled trial. Respir Res, 2020, 21(1): 113.
34.	Bai YX, Zhang JH, Zhao BC, et al. Dexmedetomidine attenuates one-lung ventilation associated lung injury by suppressing inflammatory responses: A systematic review and meta-analysis. Clin Exp Pharmacol Physiol, 2021, 48(9): 1203-1214.
35.	周瑞琴, 叶琳, 李林峻, 等. 单肺通气时间对食管癌术后肺泡灌洗液和血清炎症指标及早期肺部感染影响的前瞻性队列研究. 中国胸心血管外科临床杂志, 2018, 25(10): 855-859.
36.	支修益, 刘伦旭, 中国胸外科围手术期气道管理指南(2020 版)编写委员会. 中国胸外科围手术期气道管理指南 (2020版). 中国胸心血管外科临床杂志, 2021, 28(3): 251-262.
37.	Oshikiri T, Takiguchi G, Hasegawa H, et al. Postoperative recurrent laryngeal nerve palsy is associated with pneumonia in minimally invasive esophagectomy for esophageal cancer. Surg Endosc, 2021, 35(2): 837-844.
38.	毛友生, 赫捷, 高树庚, 等. 胸段食管癌喉返神经旁淋巴结清扫的技术要点与相关并发症的防治. 中华肿瘤杂志, 2019, 41(1): 1-5.
39.	中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识 (2018版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 崔芳芳, 何贤英, 宇传华, 等. 1990-2016年中国人群食管癌疾病负担变化趋势及危险因素分析. 中国卫生统计, 2021, 38(1): 87-91, 95.
3. Asaka S, Shimakawa T, Yamaguchi K, et al. Postoperative pneumonia after esophagectomy and systemic inflammatory response syndrome. Anticancer Res, 2019, 39(2): 979-985.
4. 于佳, 张静, 纪灏. 食管癌手术患者医院感染直接经济损失分析. 中国感染控制杂志, 2021, 20(5): 467-472.
5. Tamagawa A, Aoyama T, Tamagawa H, et al. Influence of postoperative pneumonia on esophageal cancer survival and recurrence. Anticancer Res, 2019, 39(5): 2671-2678.
6. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8. 叶韶峰. 食管癌术后肺部感染的围手术期危险因素及预防. 肿瘤学杂志, 2008, 14(5): 392-393.
9. 林晓铭, 池闯, 刘瑜, 等. 食管癌术后并发肺部感染的高危因素调查分析. 中华医院感染学杂志, 2012, 22(9): 1811-1812.
10. 高杨, 李岩, 周海英, 等. 食管癌患者术后肺部感染的影响因素分析. 中华医院感染学杂志, 2014, 24(13): 3281-3282, 3285.
11. 周小伟, 万志渝, 殷君太, 等. 食管癌手术围术期肺部感染的高危因素分析及预防. 中国胸心血管外科临床杂志, 2014, 21(5): 649-653.
12. 王启文, 曲明江, 赵晖, 等. 老年食管癌患者术后肺部感染的手术影响因素. 中国老年学杂志, 2015, 35(13): 3647-3649.
13. 谢琴, 莫占端, 华润, 等. 老年食管癌患者术后肺部感染影响因素与预防干预研究. 中华医院感染学杂志, 2016, 26(2): 346-348.
14. 谭何易, 赖应龙. 食管癌术后并发肺部感染的相关因素. 中华实验和临床感染病杂志(电子版), 2016, 10(4): 467-472.
15. 田学涛, 黄吉利. 食管癌术后肺部感染的多因素Logistic回归分析. 临床肺科杂志, 2016, 21(11): 2080-2082, 2083.
16. 王亚群, 王玲. 食管癌患者术后肺部感染的围术期影响因素分析. 临床麻醉学杂志, 2017, 33(6): 550-553.
17. 毛承毅, 柏茂树, 明波, 等. 食管癌术后肺部感染的多因素分析. 现代肿瘤医学, 2017, 25(19): 3082-3085.
18. 姚源山, 沈海波, 黄鸿渤, 等. 高龄食管癌患者术后肺部感染的相关因素分析. 中华医院感染学杂志, 2018, 28(6): 887-889.
19. 柯杨, 罗东, 柯有力. 老年食管癌根治术后发生肺部感染临床危险因素分析. 现代消化及介入诊疗, 2018, 23(5): 606-609.
20. 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.
21. 陈峙霖, 范平明, 李京泰, 等. 食管癌根治术后肺部感染病原学特点及影响因素Logistic回归分析. 中华医院感染学杂志, 2019, 29(5): 710-713.
22. 党新臣, 钱河, 赵宝生. 食管癌患者术后肺部感染危险因素分析. 新乡医学院学报, 2020, 37(10): 950-954.
23. Sakamoto K, Oka M, Yoshino S, et al. Relationship between cytokine gene polymorphisms and risk of postoperative pneumonia with esophageal cancer. J Gastrointest Surg, 2014, 18(7): 1247-1253.
24. Wei R, Dong W, Shen H, et al. Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer. Sci Rep, 2016, 6: 23636.
25. Goense L, van Rossum PS, Tromp M, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-10.
26. Liu G, Peng L, Liu B, et al. Analysis of risk factors for pulmonary infection in patients with minimally invasive esophagectomy. Oncol Lett, 2019, 17(3): 3283-3288.
27. Soutome S, Hasegawa T, Yamguchi T, et al. Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: A multicenter retrospective study of 775 patients. Support Care Cancer, 2020, 28(9): 4155-4162.
28. Crotty Alexander LE, Shin S, Hwang JH. Inflammatory diseases of the lung induced by conventional cigarette smoke: A review. Chest, 2015, 148(5): 1307-1322.
29. Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg, 2019, 43(2): 299-330.
30. Klekotka RB, Mizgała E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
31. 雷凯, 冯天赐, 赵政, 等. 慢性阻塞性肺疾病对食管癌患者术后近期预后的影响. 中国胸心血管外科临床杂志, 2022, 29(2): 200-205.
32. Pu S, Chen H, Zhou C, et al. Major Postoperative complications in esophageal cancer after minimally invasive esophagectomy compared with open esophagectomy: An updated meta-analysis. J Surg Res, 2021, 257: 554-571.
33. Li P, Gu L, Bian Q, et al. Effects of prostaglandin E 1 nebulization of ventilated lung under 60% O₂ one lung ventilation on patients' oxygenation and oxidative stress: A randomised controlled trial. Respir Res, 2020, 21(1): 113.
34. Bai YX, Zhang JH, Zhao BC, et al. Dexmedetomidine attenuates one-lung ventilation associated lung injury by suppressing inflammatory responses: A systematic review and meta-analysis. Clin Exp Pharmacol Physiol, 2021, 48(9): 1203-1214.
35. 周瑞琴, 叶琳, 李林峻, 等. 单肺通气时间对食管癌术后肺泡灌洗液和血清炎症指标及早期肺部感染影响的前瞻性队列研究. 中国胸心血管外科临床杂志, 2018, 25(10): 855-859.
36. 支修益, 刘伦旭, 中国胸外科围手术期气道管理指南(2020 版)编写委员会. 中国胸外科围手术期气道管理指南 (2020版). 中国胸心血管外科临床杂志, 2021, 28(3): 251-262.
37. Oshikiri T, Takiguchi G, Hasegawa H, et al. Postoperative recurrent laryngeal nerve palsy is associated with pneumonia in minimally invasive esophagectomy for esophageal cancer. Surg Endosc, 2021, 35(2): 837-844.
38. 毛友生, 赫捷, 高树庚, 等. 胸段食管癌喉返神经旁淋巴结清扫的技术要点与相关并发症的防治. 中华肿瘤杂志, 2019, 41(1): 1-5.
39. 中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识 (2018版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis

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