This study aimed to investigate the association between preoperative CS-30 and PPCs in patients with esophageal cancer undergoing esophagectomy, as well as to explore its clinical mechanisms.
This retrospective observational study enrolled patients with esophageal cancer undergoing esophagectomy in a single center between July 2021 and June 2023. CS-30 was measured as a modifiable risk factor for PPCs using chairs with a height of 43 cm. The primary outcome was PPCs, including pneumonia or sputum production disorder defined as Clavien-Dindo classification grade 2 or higher. We examined the association between CS-30 and PPCs using a logistic regression model. Multiple imputation was used to complete the missing data. Confounding factors were selected: age, sex, smoking status, comorbidity status, neoadjuvant therapy, ventilatory defect, surgery time, blood loss, and recurrent laryngeal nerve palsy. Sensitivity analysis was performed with pneumonia as the outcome to confirm the robustness of the findings. Patients were classified into two groups using the cutoff value (12.5) of the CS-30, and their clinical characteristics were compared.
This study included one hundred and forty-nine patients with esophageal cancer, of whom 137 patients provided complete data. The mean age of patients was 69 years, and the mean BMI was 22.1 kg/m2. 110 (80%) of the 137 patients were men, and 69 (50%) were clinical stage III/IV. The mean (standard deviation) of the preoperative CS-30 score was 16.2 (5.4), and PPCs developed in 37 patients (27%). In a logistic regression model adjustment for confounders, preoperative CS-30 was associated with PPCs (Odds ratio [95% confidence interval]: 0.87 [0.78, 0.98]). A sensitivity analysis with pneumonia as an outcome showed similar results. Patients in the group with high CS-30 scores (>12.5) started postoperative ambulation significantly earlier (3 vs. 4 days, p=0.001) and had a shorter hospital stay (22 vs. 29 days, p=0.003). Moreover, there were substantially more discharges home (79% vs. 59%, p=0.025).
A modifiable risk factor, preoperative CS-30, was associated with PPCs in patients with esophageal cancer undergoing esophagectomy. Moreover, patients with higher CS-30 scores demonstrated earlier postoperative ambulation, which may have been associated with enhanced pulmonary ventilation, reduced risk of PPCs, and earlier discharge home.
CS-30 measurement contributes to the rapid identification of high-risk cases of PPCs in patients with esophageal cancer. In cases with poor CS-30, enhanced multimodal preoperative management, especially exercise therapy, may be associated with a lower risk of PPCs. Verification of the effectiveness of such management in clinical trials is a future research priority.
Exercise tolerance
Rehabilitation
