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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
  • 15 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Notes

Acknowledgment

The Edanz Group performed English editing.

Disclosure

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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Supplementary material 2 (DOCX 14 kb)
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Supplementary material 3 (DOC 40 kb)
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Supplementary material 4 (DOC 54 kb)
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Supplementary material 5 (DOC 44 kb)

References

  1. 1.
    Lagergren J, Smyth E, Cunningham D, et al. Oesophageal cancer. Lancet. 2017;390:2383–96.CrossRefGoogle Scholar
  2. 2.
    Takeuchi H, Miyata H, Gotoh M, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260:259–66.CrossRefGoogle Scholar
  3. 3.
    Kataoka K, Takeuchi H, Mizusawa J, et al. Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: exploratory analysis of JCOG9907. Ann Surg. 2017;265:1152–7.CrossRefGoogle Scholar
  4. 4.
    Molena D, Mungo B, Stem M, et al. Incidence and risk factors for respiratory complications in patients undergoing esophagectomy for malignancy: a NSQIP analysis. Semin Thorac Cardiovasc Surg. 2014;26:287–94.CrossRefGoogle Scholar
  5. 5.
    Yoshida N, Watanabe M, Baba Y, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44:526–32.CrossRefGoogle Scholar
  6. 6.
    Kataoka K, Takeuchi H, Mizusawa J, et al. Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: exploratory analysis of JCOG9907. Ann Surg. 2017;265:1152–7.CrossRefGoogle Scholar
  7. 7.
    Saeki H, Tsutsumi S, Tajiri H, et al. Prognostic significance of postoperative complications after curative resection for patients with esophageal squamous cell carcinoma. Ann Surg. 2017;265:527–33.CrossRefGoogle Scholar
  8. 8.
    Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002;123:661–9.CrossRefGoogle Scholar
  9. 9.
    Akuzawa N, Naito H. Nutritional parameters affecting severity of pneumonia and length of hospital stay in patients with pneumococcal pneumonia: a retrospective cross-sectional study. BMC Pulm Med. 2015;15:149.CrossRefGoogle Scholar
  10. 10.
    Wei R, Dong W, Shen H, et al. Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer. Sci Rep. 2016;6:23636.CrossRefGoogle Scholar
  11. 11.
    Mariette C, Piessen G, Triboulet JP. Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol. 2007;8:545–53.CrossRefGoogle Scholar
  12. 12.
    Sunpaweravong S, Ruangsin S, Laohawiriyakamol S, et al. Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients. Asian J Surg. 2012;35:104–9.CrossRefGoogle Scholar
  13. 13.
    Raymond DP, Seder CW, Wright CD, et al. Predictors of major morbidity or mortality after resection for esophageal cancer: a society of thoracic surgeons general thoracic surgery database risk adjustment model. Ann Thorac Surg. 2016;102:207–14.CrossRefGoogle Scholar
  14. 14.
    Biere SS, van Berge Henegouwen MI, Bonavina L, et al. Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial. J Thorac Dis. 2017;9:S861–7.CrossRefGoogle Scholar
  15. 15.
    Nishigori T, Okabe H, Tanaka E, et al. Sarcopenia as a predictor of pulmonary complications after esophagectomy for thoracic esophageal cancer. J Surg Oncol. 2016;113:678–84.CrossRefGoogle Scholar
  16. 16.
    Shiozaki A, Fujiwara H, Okamura H, et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett. 2012;3:907–12.Google Scholar
  17. 17.
    Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.CrossRefGoogle Scholar
  18. 18.
    Niwa Y, Koike M, Hattori M, et al. Short-term outcomes after conventional transthoracic esophagectomy. Nagoya J Med Sci. 2016;78:69–78.Google Scholar
  19. 19.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefGoogle Scholar
  20. 20.
    Weijs TJ, Seesing MF, van Rossum PS, et al. Internal and external validation of a multivariable model to define hospital-acquired pneumonia after esophagectomy. J Gastrointest Surg. 2016;20:680–7.CrossRefGoogle Scholar
  21. 21.
    van der Sluis PC, Verhage RJ, van der Horst S, et al. A new clinical scoring system to define pneumonia following esophagectomy for cancer. Dig Surg. 2014;31:108–16.CrossRefGoogle Scholar
  22. 22.
    Kanda M, Mizuno A, Tanaka C, et al. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer. Medicine (Baltimore). 2016;95:e3781.CrossRefGoogle Scholar
  23. 23.
    Inaoka K, Kanda M, Uda H, et al. Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2–4 gastric cancer. World J Gastroenterol. 2017;23:2519–26.CrossRefGoogle Scholar
  24. 24.
    Tanaka Y, Kanda M, Tanaka C, et al. Usefulness of preoperative estimated glomerular filtration rate to predict complications after curative gastrectomy in patients with clinical T2–4 gastric cancer. Gastric Cancer. 2017;20:736–43.CrossRefGoogle Scholar
  25. 25.
    Wang R, Lagakos SW, Ware JH, et al. Statistics in medicine—reporting of subgroup analyses in clinical trials. N Engl J Med. 2007;357:2189–94.CrossRefGoogle Scholar
  26. 26.
    Nomura S, Tsujimoto H, Aosasa S, et al. Impact of angiotensin-converting enzyme 2 levels on postoperative pneumonia after esophagectomy. J Surg Res. 2018;224:200–6.CrossRefGoogle Scholar
  27. 27.
    Baba Y, Yoshida N, Shigaki H, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016;264:305–11.CrossRefGoogle Scholar
  28. 28.
    Montagnese C, Scalfi L, Signorini A, et al. Cholinesterase and other serum liver enzymes in underweight outpatients with eating disorders. Int J Eat Disord. 2007;40:746–50.CrossRefGoogle Scholar
  29. 29.
    Santarpia L, Grandone I, Contaldo F, et al. Butyrylcholinesterase as a prognostic marker: a review of the literature. J Cachexia Sarcopenia Muscle. 2013;4:31–9.CrossRefGoogle Scholar
  30. 30.
    Cheng BN, Jin YL, Chen BQ, et al. Serum cholinesterase: a potential assistant biomarker for hand, foot, and mouth disease caused by enterovirus 71 infection. Infect Dis Poverty. 2016;5:27.CrossRefGoogle Scholar
  31. 31.
    Abbas M, Abbas Z. Serum cholinesterase: a predictive biomarker of hepatic reserves in chronic hepatitis D. World J Hepatol. 2017;9:967–72.CrossRefGoogle Scholar
  32. 32.
    Brzezinski RY, Fisher E, Cohen N, et al. Total serum cholinesterase activity predicts hemodynamic changes during exercise and associates with cardiac troponin detection in a sex-dependent manner. Mol Med. 2018;24:63.CrossRefGoogle Scholar
  33. 33.
    Konopke R, Kersting S, Bunk A, et al. Colorectal liver metastasis surgery: analysis of risk factors predicting postoperative complications in relation to the extent of resection. Int J Colorectal Dis. 2009;24:687–97.CrossRefGoogle Scholar
  34. 34.
    Donadon M, Cimino M, Procopio F, et al. Potential role of cholinesterases to predict short-term outcome after hepatic resection for hepatocellular carcinoma. Updates Surg. 2013;65:11–8.CrossRefGoogle Scholar
  35. 35.
    Chen T, Wang H, Wang H, et al. POSSUM and P-POSSUM as predictors of postoperative morbidity and mortality in patients undergoing hepato-biliary-pancreatic surgery: a meta-analysis. Ann Surg Oncol. 2013;20:2501–10.CrossRefGoogle Scholar
  36. 36.
    Meguid RA, Bronsert MR, Juarez-Colunga E, et al. Surgical risk preoperative assessment system (SURPAS): III. Accurate preoperative prediction of 8 adverse outcomes using 8 predictor variables. Ann Surg. 2016;264:23–31.CrossRefGoogle Scholar
  37. 37.
    Takesue T, Takeuchi H, Ogura M, et al. A prospective randomized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal cancer. Ann Surg Oncol. 2015;22(Suppl 3):S802–9.CrossRefGoogle Scholar
  38. 38.
    Simundic AM. Measures of diagnostic accuracy: basic definitions. EJIFCC. 2009;19:203–11.Google Scholar
  39. 39.
    Kanda M, Murotani K, Tanaka H, et al. A novel dual-marker expression panel for easy and accurate risk stratification of patients with gastric cancer. Cancer Med. 2018;7:2463–71.CrossRefGoogle Scholar

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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