Assessment of Respiratory Function as a Predictor of Post-Esophagectomy Complications

Background: Esophagectomy is associated with substantial postoperative morbidity, particularly pulmonary complications. Preoperative spirometry is routinely used for risk assessment, but optimal thresholds for predicting postoperative outcomes remain unclear. This study evaluated the association between preoperative spirometry parameters and postoperative complications after esophagectomy for cancer. Methods: We retrospectively analyzed consecutive patients who underwent curative esophagectomy between January 2013 and December 2024 at a single tertiary center. All patients underwent preoperative spirometry. Postoperative complications were graded using the Clavien–Dindo classification. Patients were stratified according to percentage predicted forced expiratory volume in one second (%FEV1). Receiver operating characteristic (ROC) analysis was performed to identify optimal cut-off values, and survival was assessed using Kaplan–Meier analysis. Results: A total of 343 patients were included. Reduced preoperative %FEV1 (<90%) was significantly associated with higher rates of major postoperative complications (Clavien–Dindo ≥ 3), respiratory insufficiency/acute respiratory distress syndrome, anastomotic leakage, gastric conduit necrosis, and 90-day mortality. Multivariate analysis identified %FEV1 < 90% as the only independent predictor of major complications (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.27–4.12) and anastomotic leak (HR 2.82, 95% CI 1.30–6.17). ROC analysis identified a %FEV1 cut-off of 94.5% for predicting anastomotic leakage, with a specificity of 60.5% and a sensitivity 67.7%. No significant differences were observed in overall or disease-free survival. Conclusions: Preoperative %FEV1 is a strong independent predictor of major postoperative and anastomotic complications following esophagectomy. Routine spirometry allows effective risk stratification and may guide perioperative optimization strategies.