Association Between Preoperative Diagnosis of Small Airway Disease and Postoperative Pneumonia in Resectable Esophageal Squamous Cell Carcinoma Patients: a Retrospective Cohort Study

Background Esophageal cancer, specifically esophageal squamous cell carcinoma (ESCC), poses a significant health challenge characterized by a poor prognosis and high mortality rates. Surgical interventions, such as minimally invasive esophagectomy, are the primary treatment approach; however, the occurrence of postoperative complications, particularly pneumonia, presents substantial risks. Small airway disease (SAD) affecting the bronchioles’ small airways is a frequently underestimated respiratory condition with potential implications for the postoperative outcomes of ESCC patients. Method From January 2020 to December 2023, the McKeown procedure was exclusively utilized as the treatment modality for resectable esophageal squamous cell carcinoma patients in this retrospective study. Rigorous diagnostic criteria for small airway disease and postoperative pneumonia were employed, followed by detailed statistical analyses using logistic regression models with adjustments for confounding variables. Both multivariate and univariate logistic regression analyses were performed to identify the independent risk factors contributing to postoperative pneumonia incidence. Results A total of 293 participants were included in the analysis. Baseline characteristic analysis revealed that individuals with small airway disease exhibited impaired small airway function, lower pre-albumin levels, a higher incidence of pulmonary infection, and longer hospital stays compared to those without SAD. Univariate logistic analysis identified SAD as a strong independent predictor for postoperative pneumonia, with individuals with SAD having a significantly higher risk compared to those without SAD. Multivariate logistic analysis further confirmed this association, demonstrating a robust relationship between SAD and postoperative pneumonia risk even after adjusting for confounding factors. Conclusion The preoperative identification of SAD is significantly associated with an increased risk of postoperative pneumonia in resectable ESCC patients, highlighting the importance of addressing small airway disease in perioperative management to enhance clinical outcomes. These findings underscore the significance of recognizing and managing SAD as a potential risk factor in strategies for preventing and managing postoperative pneumonia.