Perioperative Outcomes After Combined Esophagectomy and Lung Resection

Introduction: The impact of concomitant lung resection during esophagectomy on short -term outcomes is not well characterized. This study tests the hypothesis that lung resection at the time of esophagectomy is not associated with increased perioperative morbidity or mortality. Methods: Perioperative outcomes for esophageal cancer patients who underwent esophagectomy alone (EA) were compared to patients who had concurrent esophagectomy and lung resection (EL) using the NSQIP database between 2006-2017. Predictors of morbid -ity and mortality, including combined surgery, were evaluated using multivariable logistic regression. Results: Among the 6,225 study patients, 6,068 (97.5%) underwent EA and 157 (2.5%) un-derwent EL. There were no differences in baseline characteristics between the two groups. Operating time for EL was longer than EA (median 416 versus 371 minutes, P < 0.01). Me-dian length of stay was 10 d for both groups. Perioperative mortality was not significantly different between EL and EA patients (5.1% versus 2.8%, P = 0.08). EL patients had higher rates of postoperative pneumonia (22.3% versus 16.2%, P = 0.04) and sepsis (11.5% versus 7.1%, P = 0.03), however major complication rates overall were similar (40.8% versus 35.3%, P = 0.16). Combining lung resection with esophagectomy was not independently associated with increased postoperative morbidity (AOR 1.21 [95% CI 0.87-1.69]) or mortality (AOR 1.63 [95% CI 0.74-3.58]). Conclusions: Concurrent lung resection during esophagectomy is not associated with in-creased mortality or overall morbidity, but is associated with higher rates of pneumonia be-yond esophagectomy alone. Surgeons considering combined lung resection with esophagec-tomy should carefully evaluate the patient's risk for pulmonary complications and pursue interventions preoperatively to optimize respiratory function. (c) 2021 Elsevier Inc. All rights reserved.