Airway colonisation and postoperative pulmonary complications after neoadjuvant therapy for oesophageal cancer☆
| Autor: | Pascal Thomas, Roger Giudicelli, Pierre Michelet, Xavier Benoit D’Journo, Pierre Fuentes, Martine Reynaud-Gaubert, Laurent Papazian, Christophe Doddoli |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty ARDS Esophageal Neoplasms medicine.medical_treatment Cytomegalovirus Bronchi Gastroenterology Postoperative Complications Bronchoscopy Internal medicine medicine Humans Hospital Mortality Neoadjuvant therapy Aged Retrospective Studies Respiratory Distress Syndrome Lung Bacteria medicine.diagnostic_test business.industry Fungi General Medicine Middle Aged medicine.disease Neoadjuvant Therapy Surgery Esophagectomy Trachea Bronchoalveolar lavage medicine.anatomical_structure Female Cardiology and Cardiovascular Medicine Complication business Airway Bronchoalveolar Lavage Fluid |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 33:444-450 |
| ISSN: | 1010-7940 |
| DOI: | 10.1016/j.ejcts.2007.09.046 |
| Popis: | Objective: To evaluate the clinical relevance of preoperative airway colonisation in patients undergoing oesophagectomy for cancer after a neoadjuvant chemoradiotherapy. Methods: From 1998 to 2005, 117 patients received neoadjuvant chemoradiotherapy for advanced stage oesophagealcancer. Amongthem,45 non-randomised patientsunderwenta bronchoscopic bronchoalveolar lavage(BALgroup) prior to surgery to assess airways colonisation. The remaining patients (n = 72) constituted the control group. The two groups were similar with respect to various clinical or pathological characteristics. Results: Thirteen of the 45 BAL patients (28%) had a preoperative bronchial colonisation by either potentially pathogenic micro-organisms (PPMs) (n = 7, 16%) or non-potentially pathogenic micro-organisms (n = 6, 13%). Cytomegalovirus (CMV) was cultured from BAL in four patients. Pre-emptive therapy was administrated in seven patients: four antiviral and three antibiotic prophylaxes. Postoperatively, 14 patients (19%) developed acute respiratory distress syndrome (ARDS) in the control group and three (7%) in the BAL group (p = 0.064). The cause of ARDS was attributed to CMV pneumonia in six control group patients on the basis of the results of open lung biopsies (n = 3)orBALcultures (n = 3)versus none ofthe BALgrouppatients(p = 0.08). Timingfor extubationwas shorterin theBALgroup(mean 13 3h ) as compared with the control group (mean 19.5 14 h; p = 0.039). In-hospital mortality was not significantly lower in BAL group patients when compared to that of control group patients (8% vs 12.5%). Conclusions: Airway colonisation by PPMs after neoadjuvant therapy is suggested as a possible cause of postoperative ARDS after oesophagectomy. Pre-emptive treatment of bacterial and viral (CMV) colonisation seems an effective option to prevent postoperative pneumonia. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|