Respiratory complications following minimally invasive esophagectomy: associated factors and predictive value of lung age

Background: Postoperative complications following esophageal surgery are severe, with respiratory complications being the most common. This study aims to evaluate the rate of respiratory complications and related factors post-esophagectomy and lymph node dissection for esophageal squamous cell carcinoma (ESCC). Subjects and methods: A prospective cross-sectional study was conducted from October 2022 to March 2024 on ESCC who underwent minimally invasive esophagectomy and extended two-field lymph node dissection. Results: Pneumonia was observed in 18 cases (25.7%), with 15 cases recorded as Clavien-Dindo grade II, 2 cases as grade III, and 1 case as grade IV. There were no deaths within 120 days postoperative. Factors significantly affected the respiratory complications, including recurrent laryngeal nerve (RLN) palsy ( P = 0.02), lung age ( P = 0.04), lung-age and real-age (L—R) difference—L—R ( P = 0.03), FEV1 ( P = 0.045), and the obstructive/restrictive lung disease ( P = 0.015). The average intensive care unit stay and hospital stay were longer in the group with respiratory complications ( P = 0.000 and P = 0.001, respectively). Lung age and the L-R difference were more predictive of respiratory complications than FEV1, FEV1%, and Tiffeneau index ( P < 0.05, AUC > 0.5). Thresholds of ≥23.7 years for L–R difference and ≥76.4 years for lung age were identified as predictive. Conclusion: Respiratory complications are common following esophageal cancer surgery, with a rate of 25.7%. Factors affecting the incidence of respiratory complications include RLN palsy, pulmonary age, L-R difference, FEV1, and the obstructive/restrictive lung disease. Lung age and the L-R difference were more predictive of respiratory complications than FEV1, FEV1%, and Tiffeneau index.