372. INVESTIGATION OF RISK FACTORS OF POSTOPERATIVE PNEUMONIA IN MEDIASTINOSCOPIC ESOPHAGECTOMY

Abstract

Pneumonia is a usual complication in esophagectomy. Although frequency of pneumonia in mediastinoscopic esophagectomy is low, risk factors for pneumonia are unclear. The risk factors are investigated. Two hundred and forty-four patients with mediastinoscopic esphagectomy and gastric tube reconstruction for esophageal cancer from 2016 to 2021 in our hospital were retrospectively considered in the present study. Postoperative pneumonia was diagnosed as Clavien-Dindo grade 2 or higher. Patients were divided into two groups with (n = 21) and without (n = 223) pneumonia, and background, surgical factors, or histopathological factors were investigated. Post-operative pneumonia was observed in 21 patients (8.6%), and pre-operative albumin, PNI (< 45), PLR (> 122), and operative bleeding (>134) were significantly related with post-operative pneumonia in the univariate analysis (p < 0.05). Age and previous respiratory disease were also tended to be related with post-operative pneumonia, but not significant. Low PNI was an independent risk factor of post-operative pneumonia in the multivariate analysis (p = 0.047, OR = 2.74). Post-operative pneumonia was not related to the complications, such as anastomosis leakage or recurrent nerve paralysis. No correlation with postoperative pneumonia was observed even in patients with preoperative respiratory dysfunction. PNI has been reported to be useful as a predictor of postoperative complications. In the present study, it was also a predictor factor of postoperative pneumonia. Early nutritional intervention for undernourished esophageal cancer patients may prevent postoperative pneumonia. Low PNI can be a predictive factor of postoperative pneumonia in the mediastinoscopic esophagectomy.