F-024TIME-TREND ANALYSIS OF THE PULMONARY FUNCTION AFTER SURGICAL TREATMENT FOR OESOPHAGEAL CANCER: POTENTIALITY AND ROLE OF PULMONARY REHABILITATION

Abstract

Objectives: To evaluate the postoperative pulmonary function in patients who underwent radical oesophagectomy for cancer to identify the best candidates for pulmonary rehabilitation programmes. Methods: Data of 57 patients operated from January 2006 to June 2011 were retrospectively reviewed. Thirty-eight patients (67%) underwent transhiatal cervico-laparotomic (CL-Group) and 19 (33%) a McKeown cervico-thoraco-laparotomic oesophagectomy (CTL-Group). The different surgical approach and the presence of postoperative pulmonary complications (POPC) were compared on demographical/clinical characteristics and pulmonary function (evaluated before surgery and 1 month after discharge). Results: Mean age and male/female distribution were 66.6 ± 10.6 years and 39/18, respectively. A total of 14 (24% of total sample) POPC occurred with a significantly higher occurrence in CTL-Group (71% vs 28%, P < 0.001). Preoperative pulmonary function was proven to be significantly related with occurrence of POPC (FVC: P = 0.011; FEV1: P < 0.001 and PEF: P = 0.004). A global worsening of spirometric parameters (expressed as the baseline percentage change, Δ) emerged, but this decrease was significantly higher in CTL-Group in terms of Δ-FVC (P < 0.001), Δ-FEV1 (P < 0.001) and Δ-PEF (P = 0.006). Similarly, patients who experienced a POPC, regardless of surgical approach, showed a higher reduction of pulmonary function in comparison with patients who did not (Δ-FVC: P = 0.003; Δ-FEV1: P = 0.001 and Δ-PEF: P = 0.038). Conclusions: In the context of a global reduction of pulmonary function, patients who underwent the McKeown approach or experienced a POPC showed a significantly worse pattern. On the basis of this evidence and our previous experience with postoperative pulmonary rehabilitation, we believe these patients would indeed benefit from therapeutic rehabilitative strategies in the preoperative and/or postoperative setting. This assumption is to be proven through prospective clinical trials.