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Ann Thorac Surg 2002;74:1747
© 2002 The Society of Thoracic Surgeons

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Correspondence

Pulmonary complication after esophagectomy results from multiple factors

^a Department of Thoracic Surgery, First Hospital, Beijing University, Xishiku Dajie 8, Xicheng Qu, Beijing 100034, People's Republic of China

e-mail: ycui3103{at}hotmail.com

To the Editor:

I read with interest the article by Avendano and colleagues [1]. A high incidence of pulmonary complications was associated with reduced forced expiratory volume in 1 second (FEV₁) and preoperative chemoradiotherapy. However, pulmonary complications with low frequency were reported by others [2], and I would like to discuss my personal experience.

Reduced FEV₁ is not an absolute risk factor for pulmonary complications. Patients with FEV₁ >1,000 mL may tolerate esophagectomy without a high incidence of pulmonary complication, in my experience. I think that a high incidence of pulmonary complications may also be associated with aspiration, operation with one-lung ventilation, and the fluid load.

In our hospital, the majority of patients undergoing esophagectomy do not require postoperative mechanical ventilation except for those with an extremely difficult and prolonged operation. Postoperative minor aspiration often occurs. Over one-third of patients with esophagectomy develop minor aspiration. This was proved by postoperative sputum inspection. Although postoperative aspiration has not been widely reported [3], it does exist. Aspiration often occurs immediately after extubation in patients with esophagectomy, particularly those with a high anastomosis. These patients cannot restore their protective reflex against aspiration immediately after extubation. The severity of the pulmonary complication is associated with the amount of aspiration. Anesthetists should know that repeated suction of the gastric tube, mouth, and trachea before and after extubation is important to reduce this cause of pulmonary complications.

Operation and prolonged one-lung ventilation, particularly the latter, are also associated with pulmonary complications and often require postoperative mechanical ventilation. Thus, during operation, whenever possible, double-lung ventilation should be used. In addition, careful control of water input is important. Excessive water load is associated with lung edema, infection, and insufficiency [4].

References

1. Avendano C.E., Flume P.A., Silvestri G.A., King L.B., Reed C.E. Pulmonary complications after esophagectomy. Ann Thorac Surg 2002;73:922-926.[Abstract/Free Full Text]
2. Collard J., Otte J., Reynaert M., Michel L., Carlier M., Kestens P. Esophageal resection and bypass: a 6 year experience with a low postoperative mortality. World J Surg 1991;15:635-641.[Medline]
3. Cui Y., Urschel J.D., Petrelli N.J. Pulmonary aspiration complicating esophagogastric anastomoses in rats. J Invest Surg 2000;13:71-72.[Medline]
4. Cui Y., Urschel J.D., Petrelli N.J. The effect of cardiac-pulmonary lymphatic obstruction on heart and lung function. Thorac Cardiovasc Surg 2001;45:45-50.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cui, Y. Search for Related Content PubMed PubMed Citation Articles by Cui, Y. Related Collections Esophagus - cancer