Airway colonisation and postoperative pulmonary complications after neoadjuvant therapy for oesophageal cancer

D’Journo, Xavier Benoit; Michelet, Pierre; Papazian, Laurent; Reynaud-Gaubert, Martine; Doddoli, Christophe; Giudicelli, Roger; Fuentes, Pierre A.; Thomas, Pascal Alexandre
March 2008
European Journal of Cardio-Thoracic Surgery;Mar2008, Vol. 33 Issue 3, p444
Academic Journal
Abstract: Objective: To evaluate the clinical relevance of preoperative airway colonisation in patients undergoing oesophagectomy for cancer after a neoadjuvant chemoradiotherapy. Methods: From 1998 to 2005, 117 patients received neoadjuvant chemoradiotherapy for advanced stage oesophageal cancer. Among them, 45 non-randomised patients underwent a bronchoscopic bronchoalveolar lavage (BAL group) prior to surgery to assess airways colonisation. The remaining patients (n =72) constituted the control group. The two groups were similar with respect to various clinical or pathological characteristics. Results: Thirteen of the 45 BAL patients (28%) had a preoperative bronchial colonisation by either potentially pathogenic micro-organisms (PPMs) (n =7, 16%) or non-potentially pathogenic micro-organisms (n =6, 13%). Cytomegalovirus (CMV) was cultured from BAL in four patients. Pre-emptive therapy was administrated in seven patients: four antiviral and three antibiotic prophylaxes. Postoperatively, 14 patients (19%) developed acute respiratory distress syndrome (ARDS) in the control group and three (7%) in the BAL group (p =0.064). The cause of ARDS was attributed to CMV pneumonia in six control group patients on the basis of the results of open lung biopsies (n =3) or BAL cultures (n =3) versus none of the BAL group patients (p =0.08). Timing for extubation was shorter in the BAL group (mean 13±3h) as compared with the control group (mean 19.5±14h; p =0.039). In-hospital mortality was not significantly lower in BAL group patients when compared to that of control group patients (8% vs 12.5%). Conclusions: Airway colonisation by PPMs after neoadjuvant therapy is suggested as a possible cause of postoperative ARDS after oesophagectomy. Pre-emptive treatment of bacterial and viral (CMV) colonisation seems an effective option to prevent postoperative pneumonia.


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