Postoperative Respiratory Complications and Clinical Outcome among Patients Undergoing Upper Gastrointestinal Tumor Surgery: A Systematic Review and Meta-analysis | ||||
| Ain Shams Journal of Surgery | ||||
| Volume 16, Issue 4, October 2023, Page 300-311 PDF (793.61 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/asjs.2023.325728 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Ahmed Magdy Mohamed Sayed  ; Hisham Abd El-Raouf El-Akkad; Tarek Abouzeid Osman; Ayman Hossam El-Din Abd El-Monem
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| Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt | ||||
| Abstract | ||||
| Background: Cancer’s incidence has been increasing world-wide and has become the leading cause of death in many countries. Upper Gastrointestinal cancer is highly prevalent and associated with a high mortality rate. For Upper GIT carcinomas, the mainstay of therapy is always surgery as it usually promises higher rates of survival than other treatment options. Although surgery is considered the mainstay of therapy but it may be associated with some complications and adverse events. Objective: To evaluate the post-operative respiratory complications following upper gastrointestinal tumour surgery according to timing, severity, type, incidence and possible measures for prophylaxis and management. Patients and Methods: Fifteen trials included postoperative respiratory complications and clinical outcomes among patients undergoing upper gastrointestinal tumor surgery. Outcomes of this study included pneumonia, ARDS, atelectasis, ventilator dependency, hospital mortality and chylothorax. Results: Regarding pneumonia was assessed in fifteen included studies there was no significant heterogeneity among trials (P 0.001, I2 = 97.86%), OR 0.206, 95% CI (0.157, 0.256). While ARDS was assessed in 8 included studies there was no significant heterogeneity among trials (P 0.001, I2 = 91.87%), OR 0.042, 95% CI (0.024, 0.061). Regarding Atelectasis was assessed in 4 included studies. There was no significant heterogeneity among trials (P 0.001, I2 = 99.59%), OR 0.236, 95% CI (0.018, 0.454). Regarding ventilator dependency, it was evaluated in 6 included studies there was no significant heterogeneity among trials (P 0.001, I2 = 96.17%), OR 0.099, 95% CI (0.064, 0.133). Regarding Hospital mortality due to respiratory complications it was assessed in five included studies, there was no significant heterogeneity among trials (P 0.001, I2 = 88.88%), OR 0.045, 95% CI (0.015, 0.075). Regarding chylothorax was assessed in 4 included studies, there was no significant heterogeneity among trials (P 0.004, I2 = 77.44%), OR 0.039, 95% CI (0.019, 0.059). Data Sources: Medline databases (PubMed, Medscape, and Science Direct. EMF-Portal) and all materials available in the internet till 2021. Conclusion: Our meta-analysis is done on 15 studies including 18,817 patients. Pneumonia, ARDS, ventilator dependency, atelectasis and chylothorax are statistically significant post-operative complications and are significant causes that lead to hospital mortality. Those complications are found more in patients with increase in tumor size, T4 staging, bad general condition and patients with co-morbidities. In addition, prevention of those complications by early intervention, early ambulation and well preparation of the patients pre-operatively are significant cause in decreasing the pulmonary complications post-operative. | ||||
| Keywords | ||||
| Chest complications; respiratory complications; gastrectomy; esophagectomy | ||||
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