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Clinical Importance of Sputum in the Respiratory Tract as a Predictive Marker of Postoperative Morbidity After Esophagectomy for Esophageal Cancer

Naoya Yoshida MD, PhD, Atsushi Morito MD, Yohei Nagai MD, PhD, Yoshifumi Baba MD, PhD, Yuji Miyamoto MD, PhD, Shiro Iwagami MD, PhD, Masaaki Iwatsuki MD, PhD, Yukiharu Hiyoshi MD, PhD, Kojiro Eto MD, PhD, Takatsugu Ishimoto MD, PhD, Yuki Kiyozumi MD, PhD, Taisuke Yagi MD, Daichi Nomoto MD, Takahiko Akiyama MD, Tasuku Toihata MD, Yu Imamura MD, PhD, Masayuki Watanabe MD, PhD, Hideo Baba MD, PhD
Gastrointestinal Oncology
Volume 26, Issue 8 / August , 2019



Respiratory morbidity is common after esophagectomy and can be a major cause of surgery-related mortality. Thus, it is important to identify novel predictors that can preoperatively estimate the incidence of postoperative respiratory morbidity. Asymptomatic sputum in the respiratory tract is sometimes observed on preoperative computed tomography (CT). This study aimed to determine the clinical importance of sputum in the respiratory tract as a predictor of postoperative morbidity after esophagectomy for esophageal cancer.

Patients and Methods

The study included 609 consecutive patients who underwent three-incisional esophagectomy for esophageal cancer between April 2005 and November 2018.


Among the patients, 76 (12.5%) had sputum in the respiratory tract on preoperative CT. This finding was significantly associated with older age, more extreme smoking habit, worse performance status, lower forced expiratory volume 1%, and more frequent pulmonary comorbidities. Additionally, the incidence of postoperative pneumonia was higher in these patients than in those without sputum (16 vs 8%, p = 0.028). Sputum in the main bronchus was associated with higher frequencies of morbidity of Clavien–Dindo classification (CDc) ≥ II (p = 0.019), severe morbidity of CDc ≥ IIIb (p = 0.058), pneumonia (p = 0.10), and pulmonary morbidity (p = 0.19) compared with the finding of sputum in the trachea alone. On multivariate analysis, sputum in the respiratory tract was an independent risk factor (hazard ratio, 2.07; 95% confidence interval, 1.019–4.207; p = 0.044) for postoperative pneumonia.


Sputum in the respiratory tract is a novel predictor of postesophagectomy pneumonia. Patients with sputum in the more distal respiratory tract might have high risk of postoperative morbidities.

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