AUTHOR=Lang Ke , Wang Xiaocen , Wei Tingting , Gu Zhaolin , Song Yansha , Yang Dong , Wang Hao 

TITLE=Concomitant preoperative airflow obstruction confers worse prognosis after trans-thoracic surgery for esophageal cancer

JOURNAL=Frontiers in Surgery

VOLUME=9

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.966340

DOI=10.3389/fsurg.2022.966340

ISSN=2296-875X

ABSTRACT=<sec><title>Background</title><p>Airflow obstruction is a critical element of chronic airway diseases. This study aimed to evaluate the impact of preoperative airflow obstruction on the prognosis of patients following surgery for esophageal carcinoma.</p></sec><sec><title>Methods</title><p>A total of 821 esophageal cancer patients were included and classified into two groups based on whether or not they had preoperative airflow obstruction. Airflow obstruction was defined as a forced expiration volume in the first second (FEV<sub>1</sub>)/forced vital capacity (FVC) ratio below the lower limit of normal (LLN). A retrospective analysis of the impact of airflow obstruction on the survival of patients with esophageal carcinoma undergoing esophagectomy was performed.</p></sec><sec><title>Results</title><p>Patients with airflow obstruction (102/821, 12.4%) had lower three-year overall (42/102, 58.8%) and progression-free survival rate (47/102, 53.9%) than those without airflow obstruction (<italic>P </italic>&lt; 0.001). Multivariate analyses showed that airflow obstruction was an independent risk factor for overall survival (Hazard Ratio = 1.66; 95% CI: 1.17–2.35, <italic>P </italic>= 0.004) and disease progression (Hazard Ratio = 1.51; 95% CI: 1.1–2.08; <italic>P = </italic>0.01). A subgroup analysis revealed that the above results were more significant in male patients, BMI &lt; 23 kg/m<sup>2</sup> patients or late-stage cancer (stage III-IVA) (<italic>P </italic>= 0.001) patients and those undergoing open esophagectomy (<italic>P </italic>&lt; 0.001).</p></sec><sec><title>Conclusion</title><p>Preoperative airflow obstruction defined by FEV<sub>1</sub>/FVC ratio below LLN was an independent risk factor for mortality in esophageal cancer patients after trans-thoracic esophagectomy. Comprehensive management of airflow obstruction and more personalized surgical decision-making are necessary to improve survival outcomes in esophageal cancer patients.</p></sec>