Risk Prediction of Postoperative Pneumonia After Subtotal Esophagectomy Based on Preoperative Serum Cholinesterase Concentrations

  • Mitsuro KandaEmail author
  • Masahiko Koike
  • Chie Tanaka
  • Daisuke Kobayashi
  • Masamichi Hayashi
  • Suguru Yamada
  • Kenji Omae
  • Yasuhiro Kodera
Thoracic Oncology



Patients undergoing subtotal esophagectomy for esophageal cancer frequently experience postoperative pneumonia. Development of preoperatively determined predictors for postoperative pneumonia will facilitate identifying high-risk patients and will assist with informing patients about their risk of postoperative pneumonia, enabling physicians to estimate with greater accuracy, will result in tailoring perioperative management.


Postoperative pneumonia was defined according to the revised Uniform Pneumonia Score. We analyzed the data for 355 patients to compare 32 potential predictive variables associated with postoperative pneumonia after subtotal esophagectomy.


Forty-one patients (11.5%) had postoperative pneumonia. Preoperative cholinesterase (ChE) concentrations demonstrated the greatest area under the curve value (0.662) to predict postoperative pneumonia (optimal cutoff value = 217 IU/l). Univariate analysis identified a continuous value of preoperative ChE concentration as a significant risk factor for postoperative pneumonia (P = 0.0014). Multivariable analysis using factors potentially relevant to pneumonia revealed that preoperative ChE concentration was one of independent risk factors for pneumonia after esophagectomy (P = 0.008). Patients with low ChE concentrations were at increased risk of postoperative pneumonia in most patient subgroups. Moreover, the odds ratios of low ChE concentrations were highest in patients undergoing neoadjuvant treatment. A combination of preoperative serum ChE concentrations and Brinkman index stratified patients into low, intermediate, and high risk of postoperative pneumonia.


Our findings indicate that preoperative ChE concentrations, particularly in combination with Brinkman index, may serve simply as a determined predictor of pneumonia after subtotal esophagectomy and may facilitate physicians’ efforts to reduce the incidence of postoperative pneumonia.



The Edanz Group performed English editing.


Mitsuro Kanda, Masahiko Koike, Chie Tanaka, Daisuke Kobayashi, Masamichi Hayashi, Suguru Yamada, Kenji Omae, and Yasuhiro Kodera have no conflicts of interest to disclose.

Supplementary material

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Sensitivity and specificity of the candidate predictors for postoperative pneumonia
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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Mitsuro Kanda
    • 1
    Email author
  • Masahiko Koike
    • 1
  • Chie Tanaka
    • 1
  • Daisuke Kobayashi
    • 1
  • Masamichi Hayashi
    • 1
  • Suguru Yamada
    • 1
  • Kenji Omae
    • 2
  • Yasuhiro Kodera
    • 1
  1. 1.Department of Gastroenterological Surgery (Surgery II)Nagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Innovative Research and Education for Clinicians and Trainees (DiRECT)Fukushima Medical University HospitalFukushimaJapan

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