Esophageal cancer is a common gastrointestinal cancer，and the incidence in China is the highest in the world. Esophagectomy represents the gold standard for patients with resectable esophageal cancer，but postoperative morbidity and mortality rates remain high. In recent years，there have been many reports on the pathogenesis of morbidity and mortality after esophagectomy without reaching any concrete conclusion. This review focuses on the pathogenesis，prophylaxis and therapeuticsof pulmonary infection after esophageal cancer resection．
Abstract: Objective To explore the protection of pulmonary function by shortening the thoracic opening time inesophagectomy of esophageal carcinoma. Methods A retrospective review of the postoperative pulmonary function of 54 patients with upper esophageal cancer undergoing esophagectomy with triple incisions in Tongji Hospital from January 2007 to April 2010 was conducted. The patients were divided into two groups. Twentyeight patients including 25 males and 3 females aged at 58.9±8.2 years were in in the classic procedure group, accepting classical esophagectomy with triple incision approach. Among them, there were 26 patients with squamous carcinoma and 2 with adenocarcinoma. Twentysix patients including 22 males and 4 females aged at 54.7±9.4 years were in the improved procedure group, accepting improved esophagectomy with triple incision approach. Among them, 25 patients had squamous carcinoma and 1 had adenocarcinoma. We analyzed the difference of the thoracic opening time, onelung ventilation time during the operation, arterial oxygen pressure (PaO2), arterial carbon dioxide differential pressure(PaCO2), pulse oximeter saturation (SpO2), postoperative mechanical ventilation time, intensive care unit (ICU) stay time, postoperative oxygen support days, postoperative inhospital days, and the incidence of pulmonary infection and respiratory failure between the two groups. Results There was a statistical difference between the two groups in thoracic opening time (4.7±1.2 hours versus 2.6±0.8 hours, t=7.51, Plt;0.05) and onelung ventilation time (3.7±15 hours versus 23±0.8 hours, t=4.23, Plt;0.05). The PaO2 and SpO2 on the 1st day and the 3rd day after operation were significantly lower than those before operation in both the classic procedure group (on the 1st day after [CM(159mm]operation, PaO2: F=516.03, Plt;0.05; SpO2: F=129.63, Plt;0.05; on the 3rdday after operation, PaO2: F=213.99, Plt;005; SpO2: F=61.84, Plt;0.05) and the improved procedure group (on the 1st day after operation, PaO2: F=423.56, Plt;0.05; SpO2: F=184.24, Plt;0.05; on the 3st day after operation, PaO2: F=136.78, Plt;0.05). On the 1st day after operation, PaO2 and SpO2 in the improved procedure group were significantly higher than those in the classic procedure group (F=36.20, Plt;0.05; F=93.42, Plt;0.05), while PaCO2 in the improved procedure group was significantly lower than that in the classic procedure group (F=155.49, Plt;0.05). On the 3rd day after operation, PaO2 in the improved procedure group was significantly higher than that in the classic procedure group (F=29.23, Plt;0.05). The postoperative mechanical ventilation time and ICU stay time in the improved procedure group were significantly shorter than those in the classic procedure group (t=3.81, P=0.00; t=4.65, Plt;0.05). Conclusion Improved esophagectomy of carcinoma with triple incision approach can significantly shorten the thoracic opening time and onelung ventilation time during operation, which plays a good role in protecting pulmonary function and lowering the incidence of pulmonary complications.
Abstract： Objective To analyze possible associated risk factors of postoperative pulmonary complications (PPC) after lung resection in order to decrease the incidence and mortality of PPC. Methods We reviewed the data of 302 patients including 228 males and 74 females undergoing lung resection from January 2007 to December 2009 in our department. The age of the patients ranged from 23 to 91 years old with an average age of 63.38 years. Based on the present definition of PPC, we recorded the related information and data before, during and after the operation, and observed the rate of PPC. The independent risk factors of PPC were evaluated by multiple logistic regression analysis. Results A total of 22 patients (7.28%) died during the operation and 75 patients (24.83%) experienced 110 times of PPC, the majority of which were prolonged air leak/bronchopleural fistula (8.94%, 27/302), nosocomial pneumonia (6.95%, 21/302) and acute respiratory failure (6.29%, 19/302). The results of logistic regression analysis showed that an American Society of Anesthesiology (ASA) score ≥3 (OR=2.400，P=0.020) and prolonged duration of immediate postoperative mechanical ventilation (OR=1.620，P=0.030) were independent factors associated with the development of PPC.Conclusions The ASA score based on the patients’ general condition and the function status of the main organs, and the prolonged duration of immediate postoperative mechanical ventilation are independent risk factors of PPC. In order to decrease the PPC rate, more attention should be paid to perfecting preoperative preparation, improving the function and condition of the organs, preserving pulmonary function and decreasing the duration of immediate postoperative mechanical ventilation for patients with high risk factors.
Abstract: Esophageal carcinoma is one of the most common malignant tumours in China, surgery is one of the traditional therapy with a high complications rate. Among them, the anastomotic fistula was significant. At present, with the development of surgical technique, the incidence of anastomotic fistula become lower day by day, postoperative pulmonary complications of esophageal carcinoma has taken place of anastomotic fistula and become the main complications. The causes of pulmonary complication including pulmonary embolism, infection and acute lung injury have been revealed by recent researches. This article reviews the pathogenesis， prophylaxis and therapeutics of postoperative pulmonary complications of esophageal carcinoma.
Objective To analyse postoperative complications and cause of death for carcinoma of esophagus. Methods A retrospective study was undertaken for data of 2 085 patients with esophageal carcinoma from 1963 to 2003, the patients were divided into group A (332 cases,1963-1983), group B(727 cases,1984-1993) and group C (1 026 cases,1994-2003) by time. The postoperative complications and cause of death were analysed. Results Resectability rate, incidence rate of postoperative complications and hospital mortality were 90.84%(1 894/2 085), 11.61% (242/2 085) and 1.82% (38/2 085) respectively. Main complications were pulmonary complications (3.93%,82/2 085),anastomotic leak (3.12%,59/1 894), and cardiovascular disease (1.29%,27/2 085). Resectability rate of group B and group C were higher than that of group A, incidence rate of postoperative complications and hospital mortality of group B and group C were lower than that of group A. Resectability rate of group C were higher than that of group B, incidence rate of postoperative complications except pulmonary complications and hospital mortality of group C were lower than those of group B. Conclusions Pulmonary complications and anastomotic leak are main postoperative complications and cause of hospital death for carcinoma of esophagus, they are decreasing in recent years because of the progress of anesthetic,surgical technique and perioperative management.
目的 评估对降低食管癌术后患者肺部并发症发生的预防措施。 方法 采用logistic回归的统计学方法，对胸外科1组2008年1月－2011年12月间行食管癌手术的109例患者进行回顾性分析，对所有可能的影响因素纳入研究。 结果 共计有24例患者发生肺部并发症（包括肺炎、急性呼吸窘迫综合征）；计算体质量指数测定值，累计有31例患者术前存在营养不良体质量指数测定值＜18 kg/m2，其中有11例发生肺部并发症。吸烟和糖尿病是发生肺部并发症的独立危险因素（P=0.017，0.048），34名患者进行了新辅助化学疗法（化疗），未明显增加术后肺部并发症的风险（P=0.080）。术中限制液体输入的患者，术后肺部并发症明显减少（P=0.008）。 结论 术前患者存在营养不良、吸烟史、糖尿病史及术中输入较多液体等都是患者发生肺部并发症的高危因素，但新辅助化疗未见引起肺部并发症升高。
Objective To evaluate the effect of perioperative fluid management on postoperative pulmonary complications (PPCs) of esophagectomy, and to find out the optimal scheme for perioperative fluid administration. Methods This retrospective cohort study enrolled 75 patients with esophageal squamous cell cancer who have received esophagectomy in West China Hospital from June to December 2014. We used the Kroenke's postoperative pulmonary complications classification system to define the PPCs. Patients with PPCs of grade Ⅱ-Ⅳ were considered as PPCs group (n=13, 12 males, 1 female, age of 64.62±8.64 years), and others were considered as non-complication group (n=62, 50 males, 12 females, age of 60.55±8.73 years). Intraoperative and postoperative fluid inputs and outputs as well as clinical characteristics between groups were compared. Results Between two groups, there was a great difference in postoperative albumin infusion, intraoperative fluid administration [net input, total input, net input/kg, total input/kg, net input/(kg·h) and total input/(kg·h)] and fluid input on the first postoerative 1–3 days (total input and total input/kg). The cutoff value for total input/(kg·h) in operation and total input on the first 1–3 postoerative days was 12.07 ml/(kg·h) and 178.57 ml/kg, respectively. Conclusion The speed of fluid infusion in operation and total input on postoperative 1-3 days are most important influence factors of PPCs. The speed in operation should not exceed 12.07 ml/(kg·h) and the total input on postoperative 1-3 days should not exceed 178.57 ml/kg. Within this range, an appropriate increase in fluid volume can make patients feel better.