Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Mingxin ¹ ,  ZHOU Chunjiao ² , JI Xingchen ¹ , GAO Qian ¹ , LIN Lijun ² , CAI Bingqin ²

1. Guangzhou University of Chinese Medicine, Guangzhou, 510006, P. R. China;
2. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, P. R. China;

Corresponding?author：

ZHOU Chunjiao, Email: gzchunjiao@163.com

Keywords：

Esophageal cancer; pulmonary infection; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202106031

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the risk factors for postoperative pulmonary infection in patients with esophageal cancer. Methods CNKI, Wangfang Data, VIP, CBM, PubMed, EMbase, The Cochrane Library were searched from inception to January 2021 to collect case-control studies, cohort studies and cross-sectional studies about risk factors for postoperative pulmonary infection in patients with esophageal cancer. Two researchers independently conducted literature screening, data extraction and quality assessment. RevMan 5.3 software and Stata 15.0 software were used for meta-analysis. Results A total of 20 articles were included, covering 5 409 patients of esophageal cancer. The quality score of included studies was 6-8 points. Meta-analysis results showed that age (MD=1.99, 95%CI 0.10 to 3.88, P=0.04), age≥60 years (OR=2.68, 95%CI 1.46 to 4.91, P=0.001), smoking history (OR=2.41, 95%CI 1.77 to 3.28, P<0.001), diabetes (OR=2.30, 95%CI 1.90 to 2.77, P<0.001), chronic obstructive pulmonary disease (OR=3.69, 95%CI 2.09 to 6.52, P<0.001), pulmonary disease (OR=2.22, 95%CI 1.16 to 4.26, P=0.02), thoracotomy (OR=1.77, 95%CI 1.32 to 2.37, P<0.001), operation time (MD=14.08, 95%CI 9.64 to 18.52, P<0.001), operation time>4 h (OR=3.09, 95%CI 1.46 to 6.55, P=0.003), single lung ventilation (OR=3.46, 95%CI 1.61 to 7.44, P=0.001), recurrent laryngeal nerve injury (OR=5.66, 95%CI 1.63 to 19.71, P=0.006), and no use of patient-controlled epidural analgesia (PCEA) (OR=2.81, 95%CI 1.71 to 4.61, P<0.001) were risk factors for postoperative pulmonary infection in patients with esophageal cancer. Conclusion The existing evidence shows that age, age≥60 years, smoking history, diabetes, chronic obstructive pulmonary disease, pulmonary disease, thoracotomy, operation time, operation time>4 h, single lung ventilation, recurrent laryngeal nerve injury, and no use of PCEA are risk factors for postoperative pulmonary infection in patients with esophageal cancer. Due to the limitation of the quantity and quality of included literature, the conclusion of this study still needs to be confirmed by more high-quality studies.

Citation： WANG Mingxin, ZHOU Chunjiao, JI Xingchen, GAO Qian, LIN Lijun, CAI Bingqin. Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1467-1474. doi: 10.7507/1007-4848.202106031 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	崔芳芳, 何賢英, 宇傳華, 等. 1990-2016年中國人群食管癌疾病負擔變化趨勢及危險因素分析. 中國衛生統計, 2021, 38(1): 87-91, 95.
3.	Asaka S, Shimakawa T, Yamaguchi K, et al. Postoperative pneumonia after esophagectomy and systemic inflammatory response syndrome. Anticancer Res, 2019, 39(2): 979-985.
4.	于佳, 張靜, 紀灝. 食管癌手術患者醫院感染直接經濟損失分析. 中國感染控制雜志, 2021, 20(5): 467-472.
5.	Tamagawa A, Aoyama T, Tamagawa H, et al. Influence of postoperative pneumonia on esophageal cancer survival and recurrence. Anticancer Res, 2019, 39(5): 2671-2678.
6.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7.	曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
8.	葉韶峰. 食管癌術后肺部感染的圍手術期危險因素及預防. 腫瘤學雜志, 2008, 14(5): 392-393.
9.	林曉銘, 池闖, 劉瑜, 等. 食管癌術后并發肺部感染的高危因素調查分析. 中華醫院感染學雜志, 2012, 22(9): 1811-1812.
10.	高楊, 李巖, 周海英, 等. 食管癌患者術后肺部感染的影響因素分析. 中華醫院感染學雜志, 2014, 24(13): 3281-3282, 3285.
11.	周小偉, 萬志渝, 殷君太, 等. 食管癌手術圍術期肺部感染的高危因素分析及預防. 中國胸心血管外科臨床雜志, 2014, 21(5): 649-653.
12.	王啟文, 曲明江, 趙暉, 等. 老年食管癌患者術后肺部感染的手術影響因素. 中國老年學雜志, 2015, 35(13): 3647-3649.
13.	謝琴, 莫占端, 華潤, 等. 老年食管癌患者術后肺部感染影響因素與預防干預研究. 中華醫院感染學雜志, 2016, 26(2): 346-348.
14.	譚何易, 賴應龍. 食管癌術后并發肺部感染的相關因素. 中華實驗和臨床感染病雜志(電子版), 2016, 10(4): 467-472.
15.	田學濤, 黃吉利. 食管癌術后肺部感染的多因素Logistic回歸分析. 臨床肺科雜志, 2016, 21(11): 2080-2082, 2083.
16.	王亞群, 王玲. 食管癌患者術后肺部感染的圍術期影響因素分析. 臨床麻醉學雜志, 2017, 33(6): 550-553.
17.	毛承毅, 柏茂樹, 明波, 等. 食管癌術后肺部感染的多因素分析. 現代腫瘤醫學, 2017, 25(19): 3082-3085.
18.	姚源山, 沈海波, 黃鴻渤, 等. 高齡食管癌患者術后肺部感染的相關因素分析. 中華醫院感染學雜志, 2018, 28(6): 887-889.
19.	柯楊, 羅東, 柯有力. 老年食管癌根治術后發生肺部感染臨床危險因素分析. 現代消化及介入診療, 2018, 23(5): 606-609.
20.	劉現海, 李峰, 路宏燕, 等. 肺功能指標對食管癌患者術后肺部感染的預測價值. 中華醫院感染學雜志, 2019, 29(9): 1379-1383.
21.	陳峙霖, 范平明, 李京泰, 等. 食管癌根治術后肺部感染病原學特點及影響因素Logistic回歸分析. 中華醫院感染學雜志, 2019, 29(5): 710-713.
22.	黨新臣, 錢河, 趙寶生. 食管癌患者術后肺部感染危險因素分析. 新鄉醫學院學報, 2020, 37(10): 950-954.
23.	Sakamoto K, Oka M, Yoshino S, et al. Relationship between cytokine gene polymorphisms and risk of postoperative pneumonia with esophageal cancer. J Gastrointest Surg, 2014, 18(7): 1247-1253.
24.	Wei R, Dong W, Shen H, et al. Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer. Sci Rep, 2016, 6: 23636.
25.	Goense L, van Rossum PS, Tromp M, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-10.
26.	Liu G, Peng L, Liu B, et al. Analysis of risk factors for pulmonary infection in patients with minimally invasive esophagectomy. Oncol Lett, 2019, 17(3): 3283-3288.
27.	Soutome S, Hasegawa T, Yamguchi T, et al. Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: A multicenter retrospective study of 775 patients. Support Care Cancer, 2020, 28(9): 4155-4162.
28.	Crotty Alexander LE, Shin S, Hwang JH. Inflammatory diseases of the lung induced by conventional cigarette smoke: A review. Chest, 2015, 148(5): 1307-1322.
29.	Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations. World J Surg, 2019, 43(2): 299-330.
30.	Klekotka RB, Mizga?a E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
31.	雷凱, 馮天賜, 趙政, 等. 慢性阻塞性肺疾病對食管癌患者術后近期預后的影響. 中國胸心血管外科臨床雜志, 2022, 29(2): 200-205.
32.	Pu S, Chen H, Zhou C, et al. Major Postoperative complications in esophageal cancer after minimally invasive esophagectomy compared with open esophagectomy: An updated meta-analysis. J Surg Res, 2021, 257: 554-571.
33.	Li P, Gu L, Bian Q, et al. Effects of prostaglandin E 1 nebulization of ventilated lung under 60% O₂ one lung ventilation on patients' oxygenation and oxidative stress: A randomised controlled trial. Respir Res, 2020, 21(1): 113.
34.	Bai YX, Zhang JH, Zhao BC, et al. Dexmedetomidine attenuates one-lung ventilation associated lung injury by suppressing inflammatory responses: A systematic review and meta-analysis. Clin Exp Pharmacol Physiol, 2021, 48(9): 1203-1214.
35.	周瑞琴, 葉琳, 李林峻, 等. 單肺通氣時間對食管癌術后肺泡灌洗液和血清炎癥指標及早期肺部感染影響的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2018, 25(10): 855-859.
36.	支修益, 劉倫旭, 中國胸外科圍手術期氣道管理指南(2020 版)編寫委員會. 中國胸外科圍手術期氣道管理指南 (2020版). 中國胸心血管外科臨床雜志, 2021, 28(3): 251-262.
37.	Oshikiri T, Takiguchi G, Hasegawa H, et al. Postoperative recurrent laryngeal nerve palsy is associated with pneumonia in minimally invasive esophagectomy for esophageal cancer. Surg Endosc, 2021, 35(2): 837-844.
38.	毛友生, 赫捷, 高樹庚, 等. 胸段食管癌喉返神經旁淋巴結清掃的技術要點與相關并發癥的防治. 中華腫瘤雜志, 2019, 41(1): 1-5.
39.	中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識 (2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 崔芳芳, 何賢英, 宇傳華, 等. 1990-2016年中國人群食管癌疾病負擔變化趨勢及危險因素分析. 中國衛生統計, 2021, 38(1): 87-91, 95.
3. Asaka S, Shimakawa T, Yamaguchi K, et al. Postoperative pneumonia after esophagectomy and systemic inflammatory response syndrome. Anticancer Res, 2019, 39(2): 979-985.
4. 于佳, 張靜, 紀灝. 食管癌手術患者醫院感染直接經濟損失分析. 中國感染控制雜志, 2021, 20(5): 467-472.
5. Tamagawa A, Aoyama T, Tamagawa H, et al. Influence of postoperative pneumonia on esophageal cancer survival and recurrence. Anticancer Res, 2019, 39(5): 2671-2678.
6. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
7. 曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
8. 葉韶峰. 食管癌術后肺部感染的圍手術期危險因素及預防. 腫瘤學雜志, 2008, 14(5): 392-393.
9. 林曉銘, 池闖, 劉瑜, 等. 食管癌術后并發肺部感染的高危因素調查分析. 中華醫院感染學雜志, 2012, 22(9): 1811-1812.
10. 高楊, 李巖, 周海英, 等. 食管癌患者術后肺部感染的影響因素分析. 中華醫院感染學雜志, 2014, 24(13): 3281-3282, 3285.
11. 周小偉, 萬志渝, 殷君太, 等. 食管癌手術圍術期肺部感染的高危因素分析及預防. 中國胸心血管外科臨床雜志, 2014, 21(5): 649-653.
12. 王啟文, 曲明江, 趙暉, 等. 老年食管癌患者術后肺部感染的手術影響因素. 中國老年學雜志, 2015, 35(13): 3647-3649.
13. 謝琴, 莫占端, 華潤, 等. 老年食管癌患者術后肺部感染影響因素與預防干預研究. 中華醫院感染學雜志, 2016, 26(2): 346-348.
14. 譚何易, 賴應龍. 食管癌術后并發肺部感染的相關因素. 中華實驗和臨床感染病雜志(電子版), 2016, 10(4): 467-472.
15. 田學濤, 黃吉利. 食管癌術后肺部感染的多因素Logistic回歸分析. 臨床肺科雜志, 2016, 21(11): 2080-2082, 2083.
16. 王亞群, 王玲. 食管癌患者術后肺部感染的圍術期影響因素分析. 臨床麻醉學雜志, 2017, 33(6): 550-553.
17. 毛承毅, 柏茂樹, 明波, 等. 食管癌術后肺部感染的多因素分析. 現代腫瘤醫學, 2017, 25(19): 3082-3085.
18. 姚源山, 沈海波, 黃鴻渤, 等. 高齡食管癌患者術后肺部感染的相關因素分析. 中華醫院感染學雜志, 2018, 28(6): 887-889.
19. 柯楊, 羅東, 柯有力. 老年食管癌根治術后發生肺部感染臨床危險因素分析. 現代消化及介入診療, 2018, 23(5): 606-609.
20. 劉現海, 李峰, 路宏燕, 等. 肺功能指標對食管癌患者術后肺部感染的預測價值. 中華醫院感染學雜志, 2019, 29(9): 1379-1383.
21. 陳峙霖, 范平明, 李京泰, 等. 食管癌根治術后肺部感染病原學特點及影響因素Logistic回歸分析. 中華醫院感染學雜志, 2019, 29(5): 710-713.
22. 黨新臣, 錢河, 趙寶生. 食管癌患者術后肺部感染危險因素分析. 新鄉醫學院學報, 2020, 37(10): 950-954.
23. Sakamoto K, Oka M, Yoshino S, et al. Relationship between cytokine gene polymorphisms and risk of postoperative pneumonia with esophageal cancer. J Gastrointest Surg, 2014, 18(7): 1247-1253.
24. Wei R, Dong W, Shen H, et al. Predictive effects of lung function test on postoperative pneumonia in squamous esophageal cancer. Sci Rep, 2016, 6: 23636.
25. Goense L, van Rossum PS, Tromp M, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus, 2017, 30(1): 1-10.
26. Liu G, Peng L, Liu B, et al. Analysis of risk factors for pulmonary infection in patients with minimally invasive esophagectomy. Oncol Lett, 2019, 17(3): 3283-3288.
27. Soutome S, Hasegawa T, Yamguchi T, et al. Prevention of postoperative pneumonia by perioperative oral care in patients with esophageal cancer undergoing surgery: A multicenter retrospective study of 775 patients. Support Care Cancer, 2020, 28(9): 4155-4162.
28. Crotty Alexander LE, Shin S, Hwang JH. Inflammatory diseases of the lung induced by conventional cigarette smoke: A review. Chest, 2015, 148(5): 1307-1322.
29. Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS?) Society recommendations. World J Surg, 2019, 43(2): 299-330.
30. Klekotka RB, Mizga?a E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
31. 雷凱, 馮天賜, 趙政, 等. 慢性阻塞性肺疾病對食管癌患者術后近期預后的影響. 中國胸心血管外科臨床雜志, 2022, 29(2): 200-205.
32. Pu S, Chen H, Zhou C, et al. Major Postoperative complications in esophageal cancer after minimally invasive esophagectomy compared with open esophagectomy: An updated meta-analysis. J Surg Res, 2021, 257: 554-571.
33. Li P, Gu L, Bian Q, et al. Effects of prostaglandin E 1 nebulization of ventilated lung under 60% O₂ one lung ventilation on patients' oxygenation and oxidative stress: A randomised controlled trial. Respir Res, 2020, 21(1): 113.
34. Bai YX, Zhang JH, Zhao BC, et al. Dexmedetomidine attenuates one-lung ventilation associated lung injury by suppressing inflammatory responses: A systematic review and meta-analysis. Clin Exp Pharmacol Physiol, 2021, 48(9): 1203-1214.
35. 周瑞琴, 葉琳, 李林峻, 等. 單肺通氣時間對食管癌術后肺泡灌洗液和血清炎癥指標及早期肺部感染影響的前瞻性隊列研究. 中國胸心血管外科臨床雜志, 2018, 25(10): 855-859.
36. 支修益, 劉倫旭, 中國胸外科圍手術期氣道管理指南(2020 版)編寫委員會. 中國胸外科圍手術期氣道管理指南 (2020版). 中國胸心血管外科臨床雜志, 2021, 28(3): 251-262.
37. Oshikiri T, Takiguchi G, Hasegawa H, et al. Postoperative recurrent laryngeal nerve palsy is associated with pneumonia in minimally invasive esophagectomy for esophageal cancer. Surg Endosc, 2021, 35(2): 837-844.
38. 毛友生, 赫捷, 高樹庚, 等. 胸段食管癌喉返神經旁淋巴結清掃的技術要點與相關并發癥的防治. 中華腫瘤雜志, 2019, 41(1): 1-5.
39. 中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識 (2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis

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