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Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients
INTRODUCTION: Respiratory complications (RC) including respiratory failure and adult respiratory distress syndrome (ARDS) affect the outcomes of esophagectomy substantially. In order to decrease their incidence, identification of important features of RC is necessary. AIM: To evaluate the incidence...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Termedia Publishing House
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372868/ https://www.ncbi.nlm.nih.gov/pubmed/30766629 http://dx.doi.org/10.5114/wiitm.2018.77276 |
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author | Vrba, Radek Vrána, David Neoral, Čestmír Melichar, Bohuslav Aujeský, René Tesarikova, Jana Cincibuch, Jan Zapletalová, Jana Jínek, Tomáš Stašek, Martin |
author_facet | Vrba, Radek Vrána, David Neoral, Čestmír Melichar, Bohuslav Aujeský, René Tesarikova, Jana Cincibuch, Jan Zapletalová, Jana Jínek, Tomáš Stašek, Martin |
author_sort | Vrba, Radek |
collection | PubMed |
description | INTRODUCTION: Respiratory complications (RC) including respiratory failure and adult respiratory distress syndrome (ARDS) affect the outcomes of esophagectomy substantially. In order to decrease their incidence, identification of important features of RC is necessary. AIM: To evaluate the incidence and risk factors of postoperative RC following hybrid esophagectomy. MATERIAL AND METHODS: The retrospective analysis of consecutive hybrid esophagectomies for malignancies (transhiatal laparoscopic or thoracoscopic resection and limited open reconstruction phase) assessed the incidence and outcomes of RC in relation to the patients’ age, ASA score, neoadjuvant therapy, type of surgical procedure, TNM stage, the incidence of anastomotic leak and Clavien-Dindo classification. RESULTS: Transhiatal laparoscopic (176, 81.9%) or thoracoscopic hybrid esophagectomy (39, 18.1%, conversion in 7 patients) was completed in 215 patients, 187 (87%) men and 28 (13%) women. Respiratory complications developed in 86 (40%) and severe respiratory failure or ARDS occurred in 29 (13.5%) patients. The overall in-hospital mortality was 7.4%, 30-day mortality 5.6% (RC 9, myocardial infarction 1, conduit necrosis 1), and 90-day mortality a further 1.8% (multiple organ failure, ARDS). The incidence of RC correlates significantly with ASA score II and III (p = 0.0002) and Clavien-Dindo grade 4 and 5 in severe RC (p < 0.0001). Furthermore, hospital stay (p < 0.0001) and mortality (p < 0.0001) were significantly increased in RC. CONCLUSIONS: The results show a higher occurrence of RC in polymorbid patients and patients with severe complications according to the Clavien-Dindo classification. Adequate risk management including surgical technique and perioperative prophylaxis and therapy of RC should be studied and standardized. |
format | Online Article Text |
id | pubmed-6372868 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Termedia Publishing House |
record_format | MEDLINE/PubMed |
spelling | pubmed-63728682019-02-14 Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients Vrba, Radek Vrána, David Neoral, Čestmír Melichar, Bohuslav Aujeský, René Tesarikova, Jana Cincibuch, Jan Zapletalová, Jana Jínek, Tomáš Stašek, Martin Wideochir Inne Tech Maloinwazyjne Original Paper INTRODUCTION: Respiratory complications (RC) including respiratory failure and adult respiratory distress syndrome (ARDS) affect the outcomes of esophagectomy substantially. In order to decrease their incidence, identification of important features of RC is necessary. AIM: To evaluate the incidence and risk factors of postoperative RC following hybrid esophagectomy. MATERIAL AND METHODS: The retrospective analysis of consecutive hybrid esophagectomies for malignancies (transhiatal laparoscopic or thoracoscopic resection and limited open reconstruction phase) assessed the incidence and outcomes of RC in relation to the patients’ age, ASA score, neoadjuvant therapy, type of surgical procedure, TNM stage, the incidence of anastomotic leak and Clavien-Dindo classification. RESULTS: Transhiatal laparoscopic (176, 81.9%) or thoracoscopic hybrid esophagectomy (39, 18.1%, conversion in 7 patients) was completed in 215 patients, 187 (87%) men and 28 (13%) women. Respiratory complications developed in 86 (40%) and severe respiratory failure or ARDS occurred in 29 (13.5%) patients. The overall in-hospital mortality was 7.4%, 30-day mortality 5.6% (RC 9, myocardial infarction 1, conduit necrosis 1), and 90-day mortality a further 1.8% (multiple organ failure, ARDS). The incidence of RC correlates significantly with ASA score II and III (p = 0.0002) and Clavien-Dindo grade 4 and 5 in severe RC (p < 0.0001). Furthermore, hospital stay (p < 0.0001) and mortality (p < 0.0001) were significantly increased in RC. CONCLUSIONS: The results show a higher occurrence of RC in polymorbid patients and patients with severe complications according to the Clavien-Dindo classification. Adequate risk management including surgical technique and perioperative prophylaxis and therapy of RC should be studied and standardized. Termedia Publishing House 2018-07-24 2019-01 /pmc/articles/PMC6372868/ /pubmed/30766629 http://dx.doi.org/10.5114/wiitm.2018.77276 Text en Copyright: © 2018 Fundacja Videochirurgii http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
spellingShingle | Original Paper Vrba, Radek Vrána, David Neoral, Čestmír Melichar, Bohuslav Aujeský, René Tesarikova, Jana Cincibuch, Jan Zapletalová, Jana Jínek, Tomáš Stašek, Martin Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients |
title | Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients |
title_full | Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients |
title_fullStr | Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients |
title_full_unstemmed | Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients |
title_short | Respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. Experience in 215 patients |
title_sort | respiratory complications following mini-invasive laparoscopic and thoracoscopic esophagectomy for esophageal cancer. experience in 215 patients |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372868/ https://www.ncbi.nlm.nih.gov/pubmed/30766629 http://dx.doi.org/10.5114/wiitm.2018.77276 |
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