Complications and Treatment after Esophagectomy with Extented Lymph Node Dissection for Esophageal Carcinoma

Masahiko Tsurumaru

Chief of Surgery, Toranomon Hospital

Postoperative complications and perioperative care in radical esophagectomy with three field lymph node dissection were described. The four main complications are pulmonary complications, circulatory complications, anastomotic leakage and recurrent nerve palsy. Hypoxemia was seen at a rate of 22.5%, which was caused mainly by pneumonia, atelectasis and pulmonary edema. Pulmonary edema or potential pulmonayr edema developed frequenctly after radical esophagectomy with removal of the thoracic duct, which is thought to be important for elimination of cancer cells. Combined resection of the esophagus and the thoracic duct causes hypoproteinemia or intravascular dehydration, which requires infusion of 7∼8 ml of solution/ke/h during the operation. Consequently, hypoxemia sometimes occurs in the refilling period. Howerver, it is successfully controlled by administration of DOA, albumin and a diuretic (furosemide). It should not be ingnored that dry sided maintenance of fluid, which is said to be better to obtain a sufficient level of arterial oxygen, results in serious tachycardia with hypotension. Pulmonary embolsim is a less common but serious complication, occurring at a rate of 3.3%.It is advisable to use a pneumatic cuff on both legs through the perioperative period to prevent pulmonary embolism. Administration of heparin is also effective for avoiding pulmonary embolism. Recurrent nerve palsy is one of the causative factors of pulmonary complications. We should be aware that some postiperative complications are clearly attributable to lack of skill in the techniques of operative procedures.

Key words
postoperative complications, three-field lymph node dissection, pulmonary complication

Reprint requests
Masahiko Tsurumaru Chief of Surgery, Toranomon Hospital
2-2-2 Tranomon, Minato-ku, Tokyo, 105 JAPAN

Accepted
November 15, 1995

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