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Special article: physiologic consequences of pneumonectomy. Consequences on the esophageal function. 1999
Hon Chi Suen1, Holger Hendrix, G Alexander Patterson
1Cardiothoracic Surgery Associates, S.C., 12 B Park Place, Swansea, IL 62226, USA.
Chest Surgery Clinics of North America
|December 10, 2002
Summary
Pneumonectomy significantly alters esophageal anatomy and physiology, leading to reduced peristalsis and delayed gastric emptying. These esophageal dysmotilities, often asymptomatic, may be exacerbated by surgical factors and pre-existing conditions.
Area of Science:
- Thoracic surgery
- Gastroenterology
- Esophageal physiology
Background:
- Pneumonectomy causes significant anatomical and physiological esophageal changes, including displacement, indentation, and dilatation.
- Reduced esophageal peristaltic amplitude is observed post-pneumonectomy, particularly in older patients or those operated on >6 years prior.
Discussion:
- Vagal nerve injury, ischemia, scarring, and autonomic disturbances contribute to esophageal dysmotility and delayed gastric emptying.
- Pre-existing esophageal abnormalities in lung cancer patients may be due to tumor or lymph node involvement of vagal nerves.
- Esophageal dysmotility is common after lung transplantation pneumonectomy, but its link to complications like reflux or aspiration is debated.
Key Insights:
- Despite significant esophageal morphologic and physiologic changes post-pneumonectomy, many patients remain asymptomatic.
- Esophageal dysmotility can be present before pneumonectomy due to proximity of vagal nerves to pulmonary hilum.
- Surgical technique is crucial; minimizing direct esophageal or vagal nerve injury can reduce post-operative dysmotility.
Outlook:
- Further prospective studies with larger cohorts are necessary to fully understand and manage post-pneumonectomy esophageal dysmotility.
- Investigating the long-term consequences and management strategies for esophageal functional abnormalities post-pneumonectomy is warranted.