Postoperative Hyperbilirubinemia after Surgery for Esophageal Cancer

Satoru Motoyama, Shichisaburo Abo, Michihiko Kitamura, Reijiro Saito, Masaji Hashimoto, Keiichi Izumi, Toshio Shikama, Kazuo Tenma, Shuichi Kamata, Yoshihiro Minamiya

The Second Department of Surgery, Akita University School of Medicine

From 1989 to 1993, 129 patients with thoracic and abdominal esophageal cancer underwent esophagectomy at the Second Department of Surgery, Akita University Hospital. In this study, in order to analyze the mechanism of occurrence of postoperative hyper bilirubinemia (PHB), 93 patients who underwent total or subtotal thoracic and abdominal esophagectomy without any complications were selected. They were reconstructed by cervical or upper thoracic esophagogastrostomy through the posterior mediastinal route using a right thoraco-abdominal approach. Of the 93 patients, 41 experienced PHB within 2 weeks after surgery (group H) and 52 did not (group N). We examined the preoperative residual rate of indocianine green, the preoperative creatinine clearance value, intraoperative blood loss, total volume of blood transfusion, total operation time, the duration of open chest exploration, the duration of systolic blood pressure below 100 mmHg or 80 mmHg, the urine amount during operation, and the routine laboratory tests on liver function including serum levels of bilirubin, the number of leucocyte and it's fractions from the day before surgery to the 14th postoperative day (POD). In group H, the mean value of total serum bilirubin increased to more than 2 mg/dl on the 4th POD, peaked on the 5th POD (3.6 ± 2.0 mg/dl), then dropped gradually. Intraoperative blood loss and total volume of blood transfusion were greater significant (p<0.05) in group H. The rate of occurrence of PHB was lower in patients who had been treated with prostaglandin E₁ than those who had not. That suggests that intraoperative hemodynamic factors may contribute to the pathogenesis of PHB and prostaglandin E₁ can protect the liver from sever stress.

Key words
esophageal cancer, postoperative hyperbilirubinemia, pathogenesis of hyperbilirubinemia, hemodynamic factors, prostaglandin E₁

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Satoru Motoyama The Second Department of Surgery, Akita University School of Medicine
1-1-1, Hondo, Akita, 010 JAPAN

Accepted
May 17, 1995

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