Concomitant preoperative airflow obstruction confers worse prognosis after trans-thoracic surgery for esophageal cancer

Ke Lang; Xiaocen Wang; Tingting Wei; Zhaolin Gu; Yansha Song; Dong Yang; Hao Wang

doi:10.3389/fsurg.2022.966340

Concomitant preoperative airflow obstruction confers worse prognosis after trans-thoracic surgery for esophageal cancer

Front Surg. 2023 Jan 16:9:966340. doi: 10.3389/fsurg.2022.966340. eCollection 2022.

Authors

Ke Lang¹, Xiaocen Wang¹, Tingting Wei¹, Zhaolin Gu¹, Yansha Song¹, Dong Yang^{1

2}, Hao Wang³

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
² Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China.
³ Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Background: Airflow obstruction is a critical element of chronic airway diseases. This study aimed to evaluate the impact of preoperative airflow obstruction on the prognosis of patients following surgery for esophageal carcinoma.

Methods: A total of 821 esophageal cancer patients were included and classified into two groups based on whether or not they had preoperative airflow obstruction. Airflow obstruction was defined as a forced expiration volume in the first second (FEV₁)/forced vital capacity (FVC) ratio below the lower limit of normal (LLN). A retrospective analysis of the impact of airflow obstruction on the survival of patients with esophageal carcinoma undergoing esophagectomy was performed.

Results: Patients with airflow obstruction (102/821, 12.4%) had lower three-year overall (42/102, 58.8%) and progression-free survival rate (47/102, 53.9%) than those without airflow obstruction (P < 0.001). Multivariate analyses showed that airflow obstruction was an independent risk factor for overall survival (Hazard Ratio = 1.66; 95% CI: 1.17-2.35, P = 0.004) and disease progression (Hazard Ratio = 1.51; 95% CI: 1.1-2.08; P = 0.01). A subgroup analysis revealed that the above results were more significant in male patients, BMI < 23 kg/m² patients or late-stage cancer (stage III-IVA) (P = 0.001) patients and those undergoing open esophagectomy (P < 0.001).

Conclusion: Preoperative airflow obstruction defined by FEV₁/FVC ratio below LLN was an independent risk factor for mortality in esophageal cancer patients after trans-thoracic esophagectomy. Comprehensive management of airflow obstruction and more personalized surgical decision-making are necessary to improve survival outcomes in esophageal cancer patients.

Keywords: airflow obstruction; decision-making; esophageal cancer; lung function; survival.

Grants and funding

This study was sponsored by the State's Key Project of Research and Development Plan in China (Project number 2017YFC1310602, 2017YFC1310600); National Natural Science Foundation of China (Project number 81970069, 82170091); Smart Healthcare Project of Zhongshan Hospital, Fudan University (2020ZHZS18); Shanghai Municipal Key Clinical Specialty (shslczdzk02201); Science and Technology Commmission of Shanghai Municipality (20DZ2261200).