Display options
Share it on

J Thorac Dis. 2017 Jul;9:S861-S867. doi: 10.21037/jtd.2017.06.61.

Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial.

Journal of thoracic disease

Surya Say Biere, Mark I van Berge Henegouwen, Luigi Bonavina, Camiel Rosman, Josep Roig Garcia, Suzanne S Gisbertz, Donald L van der Peet, Miguel A Cuesta


  1. Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands.
  2. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
  3. Department of Surgery, I.R.C.C.S. Policlinico San Donato University of Milan, Milan, Italy.
  4. Department of Surgery, Radboud Hospital, Nijmegen, the Netherlands.
  5. Department of Surgery, Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain.

PMID: 28815084 PMCID: PMC5538980 DOI: 10.21037/jtd.2017.06.61


BACKGROUND: The first and only randomized trial comparing open esophagectomy (OE) with minimally invasive esophagectomy (MIE) showed a significant lower incidence of post-operative respiratory infections in the patients who underwent MIE. In order to identify which specific factors are related to a better respiratory outcome in this trial an additional analysis was performed.

METHODS: This was a prospective, multicenter, randomized controlled trial. Eligible patients, with a resectable intrathoracic esophageal carcinoma, including the gastro-esophageal (GE) junction tumors and Eastern Cooperative Oncology Group ≤2, were randomized to either MIE or OE. Respiratory infection investigated was defined as a clinical manifestation of (broncho-) pneumonia confirmed by thorax X-ray and/ or Computed Tomography scan and a positive sputum culture. A logistic regression model was used.

RESULTS: From 2009 to 2011, 115 patients were randomized in 5 centers. Eight patients developed metastasis during neoadjuvant therapy or had an irresectable tumor and were therefore excluded from the analysis. Fifty-two OE patients were comparable to 55 MIE patients with regard to baseline characteristics. In-hospital mortality was not significantly different [2% (open group) and 4% (MIE group)]. A body mass index (BMI) ≥26 and OE were associated with a roughly threefold risk of developing a respiratory infection.

CONCLUSIONS: Overweight patients and OE are independently associated with a significant higher incidence of post-operative respiratory infections, i.e., pneumonia.

Keywords: Minimally invasive; esophagectomy; obesity; open esophagectomy (OE); pneumonia; respiratory infections

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.


  1. Lancet. 2012 May 19;379(9829):1887-92 - PubMed
  2. World J Surg. 2010 Nov;34(11):2621-7 - PubMed
  3. Ann Surg. 2003 Oct;238(4):486-94; discussion 494-5 - PubMed
  4. J Anesth. 2010 Oct;24(5):803-6 - PubMed
  5. Lancet Oncol. 2005 Sep;6(9):659-68 - PubMed
  6. N Engl J Med. 2002 Nov 21;347(21):1662-9 - PubMed
  7. BMJ Open. 2016 Dec 7;6(12 ):e012876 - PubMed
  8. Surg Endosc. 2008 Nov;22(11):2485-91 - PubMed
  9. Endosc Surg Allied Technol. 1994 Feb;2(1):21-5 - PubMed
  10. Br J Surg. 2012 Nov;99(11):1547-53 - PubMed
  11. J Am Coll Surg. 2006 Jul;203(1):7-16 - PubMed
  12. Surg Laparosc Endosc Percutan Tech. 2014 Apr;24(2):158-63 - PubMed
  13. N Engl J Med. 2012 May 31;366(22):2074-84 - PubMed
  14. Minerva Chir. 2009 Apr;64(2):121-33 - PubMed
  15. Surg Oncol. 2015 Sep;24(3):212-9 - PubMed
  16. J Thorac Cardiovasc Surg. 2007 Nov;134(5):1284-91 - PubMed
  17. Ann Thorac Surg. 2009 Mar;87(3):911-9 - PubMed
  18. Ann Surg Oncol. 2011 May;18(5):1460-8 - PubMed
  19. Ann Surg. 2008 Dec;248(6):1081-91 - PubMed
  20. N Engl J Med. 2006 Jul 6;355(1):11-20 - PubMed

Publication Types