Respiratory function changes after chemotherapy: an additional risk for postoperative respiratory complications?

Background: To assess respiratory function in cervical chronic compressive myelopathy (CCM) patients in pre-operative period, post-operative period and to compare pre-operative status with post-operative status. Aims and Objectives: 1. To assess respiratory function in cervical CCM patients in pre-operative period. 2. To assess respiratory function in cervical CCM patients in post-operative period, following relief of compression. 3. To compare, pre-operative status with post-operative status. Materials and Methods: A prospective study was done in 50 patients with cervical CCM due to either cervical disc disease or ossified posterior longitudinal ligament (OPLL) who were operated. None of the patients included in the study had any clinical signs & symptoms of respiratory dysfunction. Spirometry was performed in pre-operative and postoperative period after 3 months and results were analyzed. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), ratio of mean FEV1 to FVC (FEVI: FVC%) and peak expiratory flow rate (PEFR) were calculated. Results: Majority of the patients were in their fourth decade of life with male predominance. Thirty-six patients (72%) presented with prolapsed intervertebral disc and 14 patients (28%) had ossified posterior longitudinal ligament (OPLL). Patients were operated depending upon the pathology. The present study showed that there was significant reduction in preoperative FVC, FEV1, PEFR values as compared with predicted values and they showed significant improvement in post-operative period after surgical relief of compression. Conclusion: Significant yet occult respiratory dysfunction in form of impairment of various lung capacities exists in patients with cervical CCM. An objective evaluation of this occult respiratory dysfunction is essential to prognosticate, prevent respiratory complications and to improve post-operative respiratory rehabilitation. Institution of incentive spirometry as a routine in all cervical CCM cases will be of benefit in preventing respiratory complications.

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Minimally invasive oesophagectomy in the prone versus lateral decubitus position: a systematic review and meta-analysis

Diseases of the Esophagus ◽

10.1093/dote/doab042 ◽

2021 ◽

Author(s):

Dimitrios Schizas ◽

Dimitrios Papaconstantinou ◽

Anastasia Krompa ◽

Antonios Athanasiou ◽

Tania Triantafyllou ◽

...

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Meta Analysis ◽

Lateral Decubitus Position ◽

Prone Positioning ◽

Respiratory Complications ◽

Invasive Esophagectomy ◽

Postoperative Respiratory Complications ◽

Lateral Decubitus

Abstract The thoracic phase of minimally invasive esophagectomy was initially performed in the lateral decubitus position (LDP); however, many experts have gradually transitioned to a prone position (PP) approach. The aim of the present systematic review and meta-analysis is to quantitatively compare the two approaches. A systematic literature search of the MEDLINE, Embase, Google Scholar, Web of Knowledge, China National Knowledge Infrastructure and ClinicalTrials.gov databases was undertaken for studies comparing outcomes between patients undergoing minimally invasive esophageal surgery in the PP versus the LDP. In total, 15 studies with 1454 patients (PP; n = 710 vs. LDP; n = 744) were included. Minimally invasive esophagectomy in the PP provides statistically significant reduction in postoperative respiratory complications (Risk ratios 0.5, 95% confidence intervals [CI] 0.34–0.76, P < 0.001), blood loss (weighted mean differences [WMD] –108.97, 95% CI –166.35 to −51.59 mL, P < 0.001), ICU stay (WMD –0.96, 95% CI –1.7 to −0.21 days, P = 0.01) and total hospital stay (WMD –2.96, 95% CI –5.14 to −0.78 days, P = 0.008). In addition, prone positioning increases the overall yield of chest lymph node dissection (WMD 2.94, 95% CI 1.54–4.34 lymph nodes, P < 0.001). No statistically significant difference in regards to anastomotic leak rate, mortality and 5-year overall survival was encountered. Subgroup analysis revealed that the protective effect of prone positioning against pulmonary complications was more pronounced for patients undergoing single-lumen tracheal intubation. A head to head comparison of minimally invasive esophagectomy in the prone versus the LDP reveals superiority of the former method, with emphasis on the reduction of postoperative respiratory complications and reduced length of hospitalization. Long-term oncologic outcomes appear equivalent, although validation through prospective studies and randomized controlled trials is still necessary.

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