Clinical analysis of acute lung injury after esophagectomy

Acute lung injury (ALI) is one of the most severe postoperative complications after esophagectomy for esophageal cancer patients. In order to clarify the mechanism of ALI, we, therefore, studied the operative course of a group of patients who underwent elective esophagectomy.

We retrospectively analyzed 75 patients underwent an esophagectomy and reconstruction for thoracic esophageal cancer.

No statistically significant differences were observed between the two groups regarding their clinical backgrounds, such as their age, smoking index, preoperative pulmonary function, the location of the main tumor, and the tumor nodes metastasis stage. Operative time is thus considered to be a significant factor. The odds ratio (OR) of ALI in cases whose preoperative pulmonary function was 6.70 in comparison to the abnormal preoperative pulmonary functions. The OR for more intraoperative bleeding (>1000 g) was 0.83, compared with a lesser intraoperative bleeding although the difference was not statistically significant (P = 0.076). Anastomotic leakage occurred in four patients (44%) in Group I while it only occurred in two patient (6%) among the 33 Group II patients (P = 0.011).

Greater surgical stress, such as a longer operative time, is thus considered to be associated with the first attack of ALI. The adverse events developing in the extrathoracic site, such as necrosis and local infection around anastomosis may, therefore, be the second attack. Furthermore, ALI may cause not only systemic inflammatory response syndrome but also other complications such as anastomotic leakage.