Risk Factors of Postoperative Respiratory Complication after Esophagectomy from the Immunonutritional Aspects

Chikara Kunisaki, Masazumi Takahashi, Yoshihiro Moriwaki, Hirotoshi Akiyama, Osamu Kunihiro, Yoshiro Fujii, Masato Nomura and Hiroshi Shimada

Second Department of Surgery, Yokohama City University Faculty of Medicine

To clarify the risk factors of postoperative respiratory complications for patients with esophageal cancer, nutritional status and immunity were assessed in 26 patients with thoracic esophageal cancer undergoing curative resection with right side trans-thoracotomy and laparotomy. Postoperative respiratory complications were observed in five patients (19. 2%). In univariate analysis, the proportion of fat measured by indirect calorimetry significantly increased and that of carbohydrate and protein significantly decreased in complicated patietns. FEV_{1. 0}/m² significantly decreased in complicated patietns. In logistic regression analysis, retinol binding protein, the proportion of fat in indirect calorimetry, α₁-antitrypsin, duration of surgery were selected as the independent risk factor for postoperative respiratory complication. These results suggest that patients who move into fat catabolism, or starvation status, and patients with reduced retinol binding protein and α₁-antitrypsin activity have a higher postoperative morbidity rate. To prevent postoperative respiratory complications, we need appropriate nutritional support to improve nutritional immunomodulation and reduction of duration of operation.

Key words
esophageal cancer, postoperative morbidity, immunonutrition, risk factor

Reprint requests
Chikara Kunisaki Second Department of Surgery, Yokohama City University Faculty of Medicine 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JAPAN

Accepted
April 28, 1999

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