Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy

Background: Risk analysis of pulmonary complications after extended esophagectomy with three-field lymph node dissection (3FLND) has been little reported in the literature. Methods: Risk factors of developing postoperative pneumonia after extended esophagectomy and its effects on in-hospital death and overall long-term survival were compared between 38 patients who developed pneumonia and 80 patients who did not. Results: Eight patients died of postoperative complications during the hospital stay after esophagectomy. Seven of those 8 patients developed pneumonia, whereas 31 patients of 110 patients who were discharged from the hospital developed pneumonia (P < 0.01). Pneumonia occurred more frequently in elderly patients (P < 0.01), in heavy smokers (P < 0.05), in patients with preoperative pulmonary obstructive dysfunction (P < 0.05), and in patients who received 3 U or more perioperative blood transfusion (P < 0.05). Five-year overall survival rate (26.7%) of 38 patients who developed pneumonia was significantly worse than 53.4% who did not develop pneumonia (P < 0.01). Multivariate analysis of prognostic factors for overall survival showed that pathological tumor stage (hazard ratio 5.380, P < 0.01) and pneumonia (hazard ratio 2.369, P < 0.01) were independent risk factors. Postoperative pneumonia is correlated with in-hospital death and poorer long-term survival after extended esophagectomy with 3FLND. Conclusions: Elderly patients with a history of heavy smoking and poor pulmonary function should be regarded as a high-risk group of patients for developing pneumonia and very careful selection is required before subjecting such patients to extended esophagectomy. J. Surg. Oncol. 2004;88:71-77. (C) 2004 Wiley-Liss, Inc.