Effect of Perioperative Inhaled Tiotropium for patients with chronic Obstructive Pulmonary disease in Esophageal cancer surgery (EPITOPE): an open-label, randomized, parallel-group pilot study

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

General Thoracic and Cardiovascular Surgery Pub Date : 2024-09-18 DOI:10.1007/s11748-024-02083-1

Akihiko Okamura, Masayuki Watanabe, Naoki Miyazaki, Yoshiko Matsui, Haruka Manoshiro, Emi Furukawa, Yasuhiro Tai, Jun Kanamori, Yu Imamura, Satoru Kitazono

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Abstract

Objective

Chronic obstructive pulmonary disease (COPD) is a risk factor for pneumonia following esophagectomy. This study aimed to investigate the efficacy of perioperative inhaled tiotropium in patients with COPD undergoing esophagectomy.

Methods

This open-label, randomized controlled trial randomly assigned 32 patients with COPD undergoing esophagectomy to conventional management or addition of tiotropium inhalation. The intervention group received tiotropium from two weeks before esophagectomy until the final evaluation one month after esophagectomy. The primary outcome was the incidence of pneumonia within 30 postoperative days. We also assessed the changes and the percentages from baseline in pulmonary function and walking distance of the incremental shuttle walking test to just before esophagectomy and final evaluation.

Results

Enrolled patients were randomly assigned to the control group (n = 18) and the intervention group (n = 14). Pneumonia was recorded in 4 (28.6%) and 5 (27.8%) patients in the intervention and control groups, respectively (risk difference: 0.8%, 95% confidence interval: − 30.6 to 32.2). The intervention group demonstrated a significant improvement in pulmonary function and walking distance preoperatively. Further, the pulmonary function test was significantly better preoperatively in the intervention group than in the control group. Postoperatively, pulmonary function deterioration was more significant in the control group than in the intervention group.

Conclusions

Preoperative tiotropium inhalation significantly improved pulmonary function and exercise tolerance in patients with COPD undergoing esophagectomy. The perioperative tiotropium did not reduce pneumonia after esophagectomy, but it may contribute to patient recovery by reducing postoperative pulmonary function deterioration.

Abstract Image

查看原文本刊更多论文

食管癌手术围术期吸入噻托溴铵对慢性阻塞性肺病患者的影响（EPITOPE）：一项开放标签、随机、平行组试验研究

目的慢性阻塞性肺病（COPD）是食管切除术后引发肺炎的一个危险因素。本研究旨在探讨围手术期吸入噻托溴铵对接受食管切除术的慢性阻塞性肺疾病患者的疗效。方法这项开放标签、随机对照试验将 32 名接受食管切除术的慢性阻塞性肺疾病患者随机分配到常规治疗或加用噻托溴铵吸入治疗组。干预组在食管切除术前两周开始吸入噻托溴铵，直至食管切除术后一个月进行最终评估。主要结果是术后 30 天内肺炎的发生率。我们还评估了从基线到食管切除术前和最终评估期间肺功能和增量穿梭步行测试步行距离的变化和百分比。结果入组患者被随机分配到对照组（18 人）和干预组（14 人）。干预组和对照组分别有 4 名（28.6%）和 5 名（27.8%）患者发生肺炎（风险差异：0.8%，95% 置信区间：- 30.6 至 32.2）。干预组患者的肺功能和步行距离在术前有明显改善。此外，干预组术前的肺功能测试明显优于对照组。结论术前吸入噻托溴铵能明显改善接受食管切除术的慢性阻塞性肺病患者的肺功能和运动耐量。围手术期使用噻托溴铵并不能减少食管切除术后肺炎的发生，但可以通过减少术后肺功能恶化来促进患者康复。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine

CiteScore

2.70

自引率

8.30%

发文量

142

期刊介绍： The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.