Early Prediction of Postoperative Pulmonary Complications After Esophagectomy Using Lung and Diaphragmatic Ultrasound: A Multicenter Prospective Study

Abstract Background: Postoperative pulmonary complications (PPCs) remain the leading cause of morbidity and mortality after esophagectomy. Bedside tools enabling early identification of patients at risk are lacking. This study aimed to assess the ability of lung (LUS) and diaphragmatic ultrasound (DUS) to predict PPCs within seven postoperative days (POD). Methods: Multicenter prospective observational study in France including adult patients undergoing elective thoracic esophagectomy between August 2022 and March 2025. LUS and DUS were performed daily. The primary endpoint was the occurrence of at least one PPC within seven PODs. Predictive performance was assessed using multivariable logistic regression and receiver-operating-characteristic (ROC) analyses. Results: Among 275 patients, 115 (41.8%) developed PPCs. LUS on POD0 was associated with PPCs (OR 1.36, 95%CI 1.25-1.48) with an AUC of 0.74 (0.74 95%CI 0.68-0.80). LUS score on POD1 was higher in patients with PPCs (9.8±4.5 vs 5.2±3.4; p