The Impact of Oxygen Transport Variables on the Outcome in Patients Who Undergoing Surgery for Esophageal Cancer

Chikara Kusano, Masamichi Baba, Sonshin Takao, Souji Sane, Mario Shimada, Kazusada Shirao, Syouji Natsugoe, Toshitaka Fukumoto, Takashi Aikou

The First Department of Surgery, Kagoshima University, School of Medicine

The aim of this study was to assess the impact of oxygen transport variables on the outcome in 133 patients who underwent esophagectomy via a right thoracotomy and laparotomy for esophageal carcinoma. These patients were divided into two groups; The first group, 94 patients, had esophagectomy during the period 1991-July 1994, and the second groups, 39 patients, underwent the same operation during the period August, 1994-Feruary, 1996. In the first group, oxygen delivery at 6 hours after surgery in the patients with either an anastomotic leakage or respiratory failure was significantly lower than for those patients without complications. However, oxygen delivery in both groups did not differ significantly after the 1st postoperative day. In the second group, we increased oxygen delivery by using dobutamine and blood transfusion to more than 600 ml/min/m² during the period up to 12 hours after surgery. The results in the second group indicate significant reduction of morbidity and mortality when compared with the first group. In particular, anastomotic leakage (28.7% to 10.3%), respiratory failure (19.1 to 5.1%), and hospital death (8.5 to 0%) were significantly reduced. These results suggest that oxygen delivery at 6 hours after esophagectomy would be the decisive factor for postoperative complications. Furthermore, it is considered that an increase in oxygen delivery during the initial 12 hours after surgery reduces morbidity and mortality.

Key words
esophageal cancer, postoperative complication, oxygen delivery

Reprint requests
Chikara Kusano First Department of Surgery, Kagoshima University, School of Medicine
8-35-1 Sakuragaoka, Kagoshima, 890 JAPAN

Accepted
November 13, 1996

To read the PDF file you will need Abobe Reader installed on your computer.