Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer

Objectives: Pulmonary complication is a frequent morbid event after esophagectomy for cancer. Its prediction may help select patients for preoperative rehabilitation. Methods: We performed a retrospective review of 292 patients (231 men and 61 women; mean age, 60.1 years) who underwent esophagectomy for cancer between 1980 and 2000. Data were analyzed to identify factors associated with the development of pulmonary complications (reintubation for isolated respiratory failure and pneumonia). A scoring system was developed, and its ability to predict complications was assessed. Results: Resection was performed for squamous cancer (n = 100), adenocarcinoma (n = 186), and other histologic types (n = 6) in patients with stages 0 or I (n = 53), II (n = 94),111 (n = 114), and IV (n = 23) disease. Pulmonary complications, which developed in 78 (27%) patients, were associated with a 4.5-fold increase in operative mortality (7%-32%). Multivariable analysis identified independent predictors of pulmonary complications to be patient age (odds ratio [OR], 1.31; 95% confidence interval [CI], 0.99-1.74; P = .059)., percentage forced expiratory volume in 1 second (OR, 1.21; 95% CI, 1.07-1.38; P = .003), and possibly performance status (OR, 1.48; 95% Cl, 0.88-2.50; P = .14). A scoring system using these 3 covariates was developed, which predicted incremental risk of pulmonary complications (P = .013). The incremental risks of cardiovascular and overall cardiopulmonary complications were also predicted with this scoring system (P < .01 for each). Conclusions: A scoring system using patient age, spirometry, and performance status helps predict the likelihood of pulmonary and cardiovascular complications after esophagectomy and can help select patients who may benefit from preoperative cardiopulmonary rehabilitation.