Maarten van Egmond

32 Chapter 2 DISCUSSION The results of our study suggest that that IMS, HGS, PA and HRQL as part of functional status are not associated with POC in our cohort of patients with esophageal cancer undergoing esophagectomy. Although 55 out of 90 patients developed POC, there was no association found with preoperative functional status. Our findings seem to be contrary to findings related to other thoracic and abdominal surgical populations. Hulzebos et al . 10 demonstrated that higher IMS decreased the incidence of postoperative pulmonary complications in the high-risk category of coronary artery bypass graft (CABG) patients. Also, Dronkers et al . 15 indicated physical activity as a preoperative predictor of postoperative outcome in patients scheduled for major abdominal surgery. There might be three reasons why preoperative functional status in our study cohort was not found to be associated with POC. First, gastrointestinal complications represented 32.2% of POC in our study cohort. We suggest that these types of complications are due to surgical procedures and are not related to preoperative functional status. Second, the incidence of postoperative pulmonary complications in our study cohort was relatively low compared to other types of complications (Table 3). Decreased pulmonary function and IMS are known to be risk factors for postoperative pulmonary complications. 2 This was illustrated in a study of Feeney et al . 2 where preoperative pulmonary function of patients with an esophagectomy was lower than predicted (FVC: 90.3%, FEV1: 89.7% respectively). However, our study clearly revealed that pulmonary function was higher than predicted: FVC 114.8%, FEV1 109.2%, IVC 111.0% respectively. Moreover, our study showed higher preoperative IMS than their predicted normative values as well. Pulmonary function and functional status are highly interrelated and, therefore, it could be suggested that preoperative functional status in our study cohort was much better compared to other surgical populations and, therefore, led to less postoperative pulmonary complications. 9 It should also be taken into account that patients with a chronic cardio-pulmonary disease tend to be longer inactive preoperatively, subsequently leading to decreased pulmonary function, and functional status compared to our study cohort, where the disease is relatively recently diagnosed and treated by surgery.