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Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Postoperative pneumonia is a common complication after esophagectomy and is associated with a high mortality rate. Although many randomized, controlled trials have been conducted on the prevention of postoperative pneumonia, little attention has been paid to the efficacy of antimicrobial prophylaxis. The purpose of this study was to investigate the impact of antimicrobial prophylaxis on the prevention of postoperative pneumonia.

Methods

Data of patients with esophageal cancer who underwent thoracoscopic esophagectomy between 2016 and 2020 were collected. Early-period patients received cefazolin (CEZ) per protocol as antimicrobial prophylaxis (n = 250), and later-period patients received ampicillin/sulbactam (ABPC/SBT) (n = 106) because of the unavailability of CEZ in Japan. The incidence of pneumonia was compared between treatments in this quasi-experimental setting. Pneumonia detected by routine computed tomography (CT) on postoperative Days 5–6 was defined as early-onset pneumonia, and pneumonia that developed later was defined as late-onset pneumonia.

Results

The incidence of early-onset pneumonia was significantly lower (3.8% vs. 13.6%, P = 0.006), and the median length of postoperative hospital stay was significantly shorter (17 vs. 20 days, P < 0.001) in the ABPC/SBT group than in the CEZ group. The incidence of late-onset pneumonia was similar between groups (9.4% vs. 10.0%, P = 0.870). The incidence of Clostridioides difficile infections and the incidence of multidrug-resistant organisms were similar between groups. Multivariate analyses consistently showed the superiority of ABPC/SBT to CEZ in preventing early-onset pneumonia (odds ratio: 0.20, P = 0.006).

Conclusions

ABPC/SBT after esophagectomy was better at preventing early-onset pneumonia compared with CEZ and was feasible regarding the development of antimicrobial resistance.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan

    Eiji Higaki MD, PhD, Tetsuya Abe MD, PhD, Hironori Fujieda MD, PhD, Takahiro Hosoi MD, PhD, Takuya Nagao MD, Koji Komori MD, PhD, Seiji Ito MD, PhD & Yasuhiro Shimizu MD, PhD

  2. Division of Infectious Diseases, Aichi Cancer Center Hospital, Nagoya, Japan

    Naoya Itoh MD, DTM&H

  3. Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan

    Keitaro Matsuo MD, PhD

  4. Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Keitaro Matsuo MD, PhD

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  1. Eiji Higaki MD, PhD
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  2. Tetsuya Abe MD, PhD
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  3. Hironori Fujieda MD, PhD
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  4. Takahiro Hosoi MD, PhD
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Correspondence to Eiji Higaki MD, PhD.

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Higaki, E., Abe, T., Fujieda, H. et al. Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy. Ann Surg Oncol 29, 1374–1387 (2022). https://doi.org/10.1245/s10434-021-10867-5

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