An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer.
BACKGROUND
Pulmonary complications occur most frequently following a transthoracic esophagectomy for esophageal cancer and would get to be lethal occasionally. In this study, we sought to determine the effect of respiratory physiotherapy, corticosteroid administration, and the use of the video-assisted thoracoscopic (VATS) esophagectomy with a small thoracotomy incision, on the incidence of pulmonary complications following a transthoracic subtotal esophagectomy.


METHODS
Approximately 184 patients who had undergone a right transthoracic subtotal esophagectomy for squamous cell carcinoma of the thoracic esophagus were studied. To reduce the incidence of pulmonary complications, we performed clinical trials using respiratory physiotherapy, corticosteroid administration, and the VATS-esophagectomy surgical technique.


RESULTS
The independent risk factors for pulmonary complications in the multivariate logistic regression analysis were not administering corticosteroids, blood loss greater than 630 ml, and not providing respiratory physiotherapy. In addition, the use of a small surgical incision, less than 10 cm, for the thoracotomy had no effect on the prevention of pulmonary complications.


CONCLUSIONS
We concluded that patients with thoracic esophageal cancer could undergo a three-field dissection in comparative safety if the patients were provided with corticosteroid medication in the perioperative period, if the patients received sufficient respiratory physiotherapy, and if surgical blood loss was reduced.
Nakamura
Masaki
M
Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Iwahashi
Makoto
M
Nakamori
Mikihito
M
Ishida
Koichiro
K
Naka
Teiji
T
Iida
Takeshi
T
Katsuda
Masahiro
M
Tsuji
Toshiaki
T
Nakatani
Yoshihiro
Y
Yamaue
Hiroki
H
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000428:Alcohol Drinking / Q000517:prevention & control; D001945:Breathing Exercises; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011014:Pneumonia / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care; D001261:Pulmonary Atelectasis / Q000453:epidemiology / Q000517:prevention & control*; D012143:Respiratory Physiological Phenomena; D012307:Risk Factors; D016540:Smoking Cessation; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy
D000305:Adrenal Cortex Hormones