Respiratory morbidity and mortality following transhiatal oesophagectomy in patients with severe chronic obstructive pulmonary disease.

In order to assess the influence of severe chronic obstructive pulmonary di sease on the pulmonary morbidity and mortality following transhiatal oesoph agectomy, the authors reviewed 136 consecutive patients who underwent oesop hageal cancer resection by a transhiatal approach. Nineteen patients had a forced expiratory volume in one second (FEV) lower than 60 % of the theoret ical value, indicating severe chronic obstructive pulmonary disease. The ot her group of 117 patients had a FEV higher than 60 % of the theoretical val ue. Pulmonary complications occurred in 36 patients: 23 (64 %) were minor a nd 13 (36 %) were major. Seven chronic obstructive pulmonary disease did no t significantly increase pulmonary morbidity. However, pulmonary complicati ons occurring in this group of patients appeared more severe with a signifi cant increase in major pulmonary complications (21 % versus 8%, p = 0,05) a nd respiratory mortality rates (10% Versus 1,6 %, p = 0,04). One factor was significantly correlated to respiratory mortality: age higher than 75 year s (p = 0,006). Severe chronic obstructive pulmonary disease does not consti tute a contraindication for transhiatal oesophagectomy. However, this appro ach should be reserved for patients under 75 years of age, in order to obta in respiratory morbidity and mortality rates comparable to those of patient s with normal spirometry.