Possibilities in Multidisciplinary Team for Esophageal Cancer: A Propensity Score Matching Analysis

Background Esophageal cancer surgery is known to have a high complication and fatality rate, and we believe that there is an urgent need to address respiratory complications in particular. Multidisciplinary team for esophageal cancer has been established all over the world, and we have introduced our own coughing technique to prevent postoperative respiratory complications. This method is called the bilateral flank or thoracic compression maneuver, which involves coughing and expectorating while applying pressure without directly touching the abdominal or thoracic wounds. This coughing technique is believed to decrease wound pain and facilitate coughing and expectoration. Methods The study subjects were 208 and 238 cases without and with team medical intervention who underwent esophageal cancer surgery at our department between 2017 and 2024. A propensity score for each patient was calculated by multivariate logistic regression analysis using age, sex, BMI, histopathological type, cT and N, thoracic and abdominal approaches, dissected field, substitution organ, reconstructed route, thoracic duct preservation, preoperative chemotherapy, residual tumor, operative time, and hemorrhage as covariates. Propensity score matching was performed between the non-intervention and intervention groups, and postoperative respiratory complications, postoperative hospital stay, and length of stay in the ICU were compared retrospectively. Results Propensity score matching revealed 110 cases in each group. The incidence of postoperative respiratory complications (20.0% vs. 9.1%, P = 0.024) was significantly reduced in the non-intervention group vs. the intervention group by the team medicine intervention. Postoperative hospital stay (29 vs. 21 days, P = 0.004) and length of ICU stay (3.1 vs. 2.4 days, P = 0.025). Conclusion Team medical intervention combining respiratory rehabilitation by physical therapists, swallowing training by speech-language pathologists, and pain control during coughing and expectorating by the cough assistance method may have contributed to a decrease in postoperative respiratory complications. Multifaceted support in esophageal cancer treatment centers has the potential to reduce postoperative respiratory complications after esophageal cancer surgery.