Abstract
PURPOSE: Neoadjuvant immunochemotherapy (NICT) has shown promise in improving the oncological outcomes of locally advanced esophageal cancer (LAEC). However, concerns remain regarding its potential to induce pulmonary side effects that may increase the risk of perioperative adverse events. This study aimed to compare the incidence of postoperative pulmonary complications (PPCs) in patients receiving NICT and those undergoing non-neoadjuvant therapy. PATIENTS AND METHODS: This retrospective cohort study included 274 patients with LAEC who received either NICT or non-neoadjuvant therapy followed by radical esophagectomy. Propensity score matching was used to balance patient characteristics between the two groups. The primary outcome was the incidence of PPCs within the first seven days postoperatively. Conditional logistic regression models were used to assess the association between NICT and PPCs. Sensitivity analysis using inverse probability of treatment weighting was conducted to validate the robustness of the findings. RESULTS: A total of 182 patients were included in the final analysis, with 91 patients in each group. The incidence of PPCs was significantly higher in the NICT group than in the control group (46.2% vs 26.4%, P = 0.009). Respiratory infections (37.4% vs 22.0%, P = 0.035) and pleural effusions (22.0% vs 9.9%, P = 0.043) were more frequent in the NICT group. New-onset arrhythmia was the most common cardiovascular complication, with tachycardia occurring in 24.2% of patients in the NICT group compared to 9.9% in the control group (P = 0.018). Conditional logistic regression analysis revealed a significant association between NICT and PPCs (OR = 5.648, 95% CI: 1.579-20.204, P = 0.008). Sensitivity analysis using IPTW further confirmed these results (OR = 2.893, 95% CI = 1.537-5.446, P = 0.001). CONCLUSION: Patients with locally advanced esophageal cancer who received at least two cycles of NICT had a significantly increased risk of developing postoperative pulmonary complications.