# The impact of preoperative oropharyngeal microflora, decontamination, and postoperative nosocomial and opportunistic infections on the occurrence of respiratory complications in patients undergoing esophagectomy for esophageal cancer after chemoradiotherapy. A single-center cohort

## TL;DR

This study examines how preoperative and postoperative infections affect respiratory complications in patients undergoing esophagectomy for cancer.

## Contribution

The study highlights the role of microbiological decontamination in reducing postoperative infections and complications.

## Key findings

- Patients without eradication had more pneumonias caused by Escherichia coli and other pathogens.
- Postoperative positivity for Citrobacter freundi and E. coli significantly increased the odds of anastomotic leakage.
- Nosocomial and opportunistic infections are major contributors to postoperative pulmonary complications.

## Abstract

Surgical oesophagectomy remains the primary curative treatment for oesophageal cancer. It is a challenging procedure that carries the possibility of serious postoperative complications.

Retrospective analysis of preoperative oropharyngeal microbiologic cultivation, the role of decontamination, and the postoperative microbiologic cultivation in patients after hybrid esophagectomy with mild or severe respiratory complications (pneumonia and respiratory failure), and anastomotic leakage.

Significantly more pneumonias were found in the group without eradication (Escherichia coli, facultative anaerobe, p=0.016) and in the group with new infection (Pseudomonas aeruginosa (hospital-acquired infection, p<0. 0001), Enterobacter cloacae (facultatively anaerobic, p=0.032), E. coli (facultative anaerobes, p<0.0001), Klebsiela pneumoniae (hospital-acquired infection, p<0.0001), Staphylococcus aureus (facultative anaerobe, p=0.0001), Acinetobacter junii (nosocomial infection, p=0.032), and Candida albicans (opportunistic pathogenic yeast, p<0.0001)) p<0.0001. Postoperative positivity for Citrobacter freundi increased the odds of leak by 10.76 times (facultative anaerobic, p=0.042, OR 10.76), and for E. coli by 3.17 times (p=0.017, OR 3.17).

Despite the use of targeted antibiotic therapy, a significant proportion of opportunistic and nosocomial infections still occur in the pattern of postoperative respiratory and anastomotic complications in patients after esophagectomy.

The online version contains supplementary material available at 10.1007/s00423-026-03966-y.

The article evaluates the importance of preoperative targeted microbiological decontamination in esophagectomy and the prevention of nosocomial infection. Nosocomial and opportunistic infections are significant sources of pulmonary complications and septic conditions, which can be prevented to improve postoperative morbidity.

The online version contains supplementary material available at 10.1007/s00423-026-03966-y.