Postoperative care and management following three kinds of operation for esophageal cancer.
A total 100 esophageal resections were performed over a recent two year period, employing the following three kinds of operative procedure on 3 groups of patients. Group A, comprised of 37 patients, underwent transhiatal esophagectomy and reconstruction through the posterior mediastinal route. Group B, comprised of 35 patients, underwent resection through a right thoracotomy with reconstruction via the retrosternal route. The 28 patients in group C were further divided into 2 subgroups according to age and underwent a two-stage operation, in which the interval between the first and second operation was 43 hours. The operative mortality rates in each group were 2.7 per cent, 2.9 per cent and 7.1 per cent, in groups A, B and C, respectively. In analyzing the pre- and postoperative cardiopulmonary function, the changeable movement in mean left ventricular stroke work index (LVSWI) was remarkable in group C. In the younger subgroup, and less than 55, the mean LVSWI decreased to 30.3 g.m/m2 12 hours postoperatively, whereas in the older subgroup, and greater than or equal to 55 years, it was significantly (p less than 0.05) higher than that of group A plus group B 48 hours after the first operation; in other words, immediately after the second operation. Consequently, strict control of the flow volume of patients undergoing a two-stage operation is essential in order to optimise the advantages of this method.
Kudo
T
T
Department of Surgery, Technical University of Munich, Federal Republic of Germany.
Siewert
J R
JR
Bartels
H
H
D000230:Adenocarcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004944:Esophagoplasty; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology; D013908:Thoracotomy; D016277:Ventricular Function, Left / Q000502:physiology