OGC SO28 - Predictors of Pulmonary Complications Following Thoracoscopic Oesophagectomy

Abstract Background Thoracoscopic oesophagectomy, a minimally invasive technique, is associated with less postoperative pain and reduced pulmonary dysfunction. There is a correlation between preoperative cardiopulmonary fitness and postoperative outcomes, with certain variables linked to a higher risk of complications following oesophagogastric cancer surgery. This review aims to identify variables that correlate with pulmonary complications after oesophagectomy. Method A retrospective review of patients undergoing thoracoscopic oesophagectomy between 2014 -2022 at a single oesophagogastric unit was performed. 96 patients were identified and separated into two groups (19 with serious complications (SC) (greater than Clavien Dindo 3b), and 77 without serious complications (Clavien Dindo 3a and below)(NC). The primary outcomes measured included FEV1, FVC, VE/VCO2, VO2 Peak, anaerobic threshold, Estimated Met Score (EMS). Secondary outcomes measured preexisting pulmonary complications, smoking status and operating (chest time, one lung ventilation time (OLVT)). Results Groups were similar in age, gender, BMI, ASA, and clinical stage. SC had a significantly less number of smokers (p=0.004) and less individuals with pulmonary disease (p=0.019). AT was higher in NC (14.15 vs 13.50, p=0.355) and VE/VCO2 was significantly greater in SC (28 vs 32, p=0.018). SC had a significantly lower FEV1 and FVC (2.12 vs 2.81, p=0.009 and 3.11 vs 3.80, p=0.010) and a trend towards a lower EMS (6.95 vs 7.25, p=0.245). There was no significant difference in chest time between NC and SC (295min vs 265min, p=0.151) and OLVT (270min vs 245min, p=0.381) in both groups. Conclusion VE/VCO2 ratio in thoracoscopic oesophagectomy patients is a significant predictor of postoperative complications and has increasing links to adverse outcomes. Smoking status and pulmonary history do not significantly correlate with pulmonary complications in our cohort. Lower EMS, FEV1, and FVC are significantly associated with complications. Although preoperative inspiratory muscle training has not broadly impacted postoperative outcomes, it may benefit specific groups. These variables are crucial for clinicians to consider when counselling patients and planning prehabilitation.