Introduction and objectives: Complications are numerous in esophageal surgery, especially pulmonary, being the
main cause of postoperative morbidity and mortality, therefore a good respiratory
functional assessment is essential to reduce them but there are little literature
on how to perform preoperative functional assessment.
Material and methods: Two-year prospective and observational study, with a cohort of 46 patients with early
diagnosis of esophageal neoplasm, who were referred to our Unit for functional tests
(preoperative assessment). Clinical data, respiratory function tests and cardiopulmonary
exercise stress test on bicycle ergometer were taken into account. In the absence
of defined criteria to calculate the postoperative values for this type of surgery,
a risk similar to that corresponding to a mean lobectomy was considered using the
Alessandro Brunelli et al scheme of the American College of Chest Physicians (ACCP).
Results: Forty-six cases were evaluated with an accumulated average tobacco consumption of
43.2 ± 17.5 pack/year. 78.3% were males. The average age of the intervened patients
was 61.7 ± 8.1 years and the non-intervened patients 73 ± 6.8 years, (p < 0.05). Operated
patients present better functional tests (p < 0.05). There were 13 patients with moderate
risk and 10 with low risk, no case of high risk. The survival was 15 ± 11.4 months
in both groups without statistical significance.
Conclusion: Operated patients had a better clinical and respiratory situation. Functional evaluation
can reduce postoperative complications thanks to an adequate selection of patients
at high surgical risk. A study with a larger number of patients will allow us to perform
an algorithm with specific functional criteria for patients that are subsidiary to
this type of surgery.
Table 1
|
|
Half
|
Typical deviation
|
|
Age
|
64.34
|
9.31
|
|
Weight (kg)
|
71.24
|
12.36
|
|
Size (cm)
|
165.58
|
9.01
|
|
Actual FEV1 (ml)
|
2545
|
881
|
|
FEV1 (%)
|
81.38
|
19.06
|
|
Actual DLCO (ml CO/min/mmHg)
|
6.36
|
2.26
|
|
DLCO (%)
|
80.15
|
26.53
|
|
VO2max (ml/min)
|
941.92
|
273.85
|
|
VO2max (%)
|
54.78
|
16.53
|
|
FEV1 ppo (ml)
|
2226.87
|
788.27
|
|
FEV1 ppo (%)
|
71.75
|
17.33
|
|
DLCO ppo (ml CO/min/mmHg)
|
5.60
|
1.84
|
|
DLCO ppo (%)
|
71.80
|
20.07
|
|
VO2max ppo (ml/min)
|
828.89
|
241.09
|
|
VO2max ppo (%)
|
48.92
|
12.85
|
|
VO2max ppo (ml/min/kg)
|
9.39
|
0.55
|
Table 2
|
|
Intervened
|
Not intervened
|
|
|
Half
|
Typical deviation
|
Half
|
Typical deviation
|
|
Age
|
61.74
|
8.15
|
73.00
|
6.81
|
|
Weight (kg)
|
72.18
|
11.32
|
67.38
|
12.64
|
|
Size (cm)
|
165.59
|
8.65
|
165.08
|
11.07
|
|
Actual FEV1 (ml)
|
2750
|
852.38
|
2020
|
875.76
|
|
FEV1 (%)
|
86.95
|
16.72
|
66.90
|
20.62
|
|
Actual DLCO (ml CO/min/mmHg)
|
6.62
|
1.93
|
5.67
|
1.91
|
|
DLCO (%)
|
77.59
|
26.77
|
72.66
|
21.22
|
|
VO2max (ml/min)
|
985.48
|
311.42
|
858.75
|
217.74
|
|
VO2max (%)
|
54.35
|
18.58
|
60.13
|
17.82
|
|
FEV1 ppo (ml)
|
2460.65
|
758
|
1777
|
770.67
|
|
FEV1 ppo (%)
|
77.48
|
15.14
|
58.80
|
18.25
|
|
DLCO ppo (ml CO/min/mmHg)
|
5.92
|
1.74
|
4.91
|
1.62
|
|
DLCO ppo (%)
|
72.38
|
17.02
|
58.80
|
18.25
|
|
VO2max ppo (ml/min)
|
867.24
|
274.23
|
755.75
|
191.58
|
|
VO2max ppo (%)
|
49.05
|
13.25
|
53.13
|
15.74
|
|
VO2max ppo (ml/min/kg)
|
10.90
|
0.51
|
8.25
|
0.62
|
|
Survived
|
15.83
|
11.20
|
15.00
|
11.04
|
