Journal of thoracic disease · 2026
Preservation of the right bronchial artery by maintaining the azygos arch during minimally invasive esophagectomy: a two-center retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Tsuda Yasuo, Nakanoko Tomonori, Kimura Yasue, Natsugoe Keita, Hu Qingjiang, Kawazoe Tetsuro, Nambara Sho, Ando Koji, Ninomiya Mizuki, Oki Eiji, Yoshizumi Tomoharu
Аннотация
BACKGROUND: Postoperative pneumonia remains one of the most frequent and clinically important complications after esophagectomy for esophageal cancer. Research suggests that preservation of the bronchial arterial blood supply reduces pulmonary complications; however, a reproducible surgical strategy applicable to routine practice has yet been established. This study aimed to evaluate whether intentional preservation of the azygos arch as a structural strategy was associated with a reduced incidence of postoperative pneumonia.
METHODS: We retrospectively analyzed patients who underwent minimally invasive McKeown esophagectomy for esophageal cancer at two institutions between April 2015 and December 2023. Patients were classified according to whether an intentional azygos arch-preservation strategy was applied to structurally protect the right bronchial artery (RBA). Postoperative pneumonia was the primary outcome. Multivariable logistic regression analysis was performed to identify factors independently associated with postoperative pneumonia, adjusting for patient background, tumor characteristics, surgical approach, reconstruction route, preoperative treatment, year of surgery, and institution.
RESULTS: Postoperative pneumonia occurred less frequently in patients managed with the azygos arch-preservation strategy than in those who underwent resection (8% vs. 17%, P=0.01). In multivariable analysis showed that, the azygos arch-preservation strategy was independently associated with a lower risk of postoperative pneumonia [adjusted odds ratio (OR) =0.21; 95% confidence interval (CI): 0.08-0.53; P=0.001], whereas male sex and surgical approach were associated with postoperative pneumonia. Preservation of the azygos arch did not compromise upper mediastinal lymph node dissection.
CONCLUSIONS: An intentional azygos arch-preservation strategy during minimally invasive esophagectomy was independently associated with a reduced risk of postoperative pneumonia without compromising oncological adequacy. This reproducible surgical approach represents a practical strategy to improve postoperative respiratory outcomes in esophageal cancer surgery.
METHODS: We retrospectively analyzed patients who underwent minimally invasive McKeown esophagectomy for esophageal cancer at two institutions between April 2015 and December 2023. Patients were classified according to whether an intentional azygos arch-preservation strategy was applied to structurally protect the right bronchial artery (RBA). Postoperative pneumonia was the primary outcome. Multivariable logistic regression analysis was performed to identify factors independently associated with postoperative pneumonia, adjusting for patient background, tumor characteristics, surgical approach, reconstruction route, preoperative treatment, year of surgery, and institution.
RESULTS: Postoperative pneumonia occurred less frequently in patients managed with the azygos arch-preservation strategy than in those who underwent resection (8% vs. 17%, P=0.01). In multivariable analysis showed that, the azygos arch-preservation strategy was independently associated with a lower risk of postoperative pneumonia [adjusted odds ratio (OR) =0.21; 95% confidence interval (CI): 0.08-0.53; P=0.001], whereas male sex and surgical approach were associated with postoperative pneumonia. Preservation of the azygos arch did not compromise upper mediastinal lymph node dissection.
CONCLUSIONS: An intentional azygos arch-preservation strategy during minimally invasive esophagectomy was independently associated with a reduced risk of postoperative pneumonia without compromising oncological adequacy. This reproducible surgical approach represents a practical strategy to improve postoperative respiratory outcomes in esophageal cancer surgery.