Prostaglandin E1 ameliorates decreased tracheal blood flow after esophagectomy and aggressive upper mediastinal lymphadenectomy for esophageal carcinoma.
BACKGROUND
Aggressive upper mediastinal lymphadenectomy contributes to a better survival rate after esophageal resection to treat esophageal carcinoma, but it also increases postoperative respiratory complications. Devascularization of the airways because of mediastinal dissection is considered to be a cause of respiratory dysfunction. The present study attempts to clarify whether or not tracheal blood flow (TBF) deteriorates after esophagectomy and, if so, whether or not intravenous prostaglandin E1 (PGE1) attenuates the deterioration.


METHODS
Patients undergoing esophagectomy and aggressive upper mediastinal lymphadenectomy for the treatment of esophageal carcinoma (EC group, n = 12) or abdominal surgery (control group, n = 6) were enrolled in this study. Measurement of TBF was performed using a laser Doppler flowmeter. Changes in TBF induced by surgery and postoperative intravenous PGE1 were studied in both groups.


RESULTS
The TBF deteriorated significantly in the EC group (21.78 +/- 9.60 to 11.24 +/- 4.45 mL/minute/10(-1) kg, p = 0.002) but did not change in the control group (26.13 +/- 6.84 to 26.61 +/- 4.69 mL/minute/10(-1) kg, p = 0.7371). Postoperative intravenous PGE1 partially, but significantly, reversed the deterioration in TBF in the EC group (11.53 +/- 4.58 to 14.87 +/- 6.30 mL/minute/10(-1) kg, p = 0.0207) but did not effect the control group (29.41 +/- 7.89 to 29.41 +/- 8.79 mL/minute/10(-1) kg, p = 0.9989).


CONCLUSIONS
Esophagectomy and aggressive upper mediastinal lymphadenectomy cause a deterioration in TBF that is partially attenuated by PGE1.
Hasegawa
S
S
Department of Critical Care Medicine, Kyoto University Hospital, Japan.
Imamura
M
M
Shimada
Y
Y
Kanda
Y
Y
Wada
H
H
Hitomi
S
S
Mori
K
K
D000527:Alprostadil / Q000627:therapeutic use*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008197:Lymph Node Excision; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D011182:Postoperative Care; D012039:Regional Blood Flow / Q000187:drug effects; D014132:Trachea / Q000098:blood supply*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D000527:Alprostadil