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Severe Postoperative Complications may be Related to Mesenteric Traction Syndrome during Open Esophagectomy

R Ambrus1, L B Svendsen1, N H Secher2

  • 11 Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society
|July 25, 2017
PubMed
Abstract

Insights

Mesenteric traction syndrome, causing hypotension and flushing, is more common in open esophagectomy. Severe complications are linked to significant mesenteric traction syndrome during surgery.

Area of Science:

  • Surgical Physiology
  • Gastrointestinal Surgery

Background:

  • Mesenteric traction during abdominal surgery can induce mesenteric traction syndrome (MTS), characterized by hypotension, tachycardia, and increased prostacyclin (PGI2).
  • The relationship between MTS and postoperative complications following esophagectomy remains unclear.

Purpose of the Study:

  • To investigate the occurrence of MTS during open and robotically assisted esophagectomy.
  • To determine if MTS is associated with postoperative complications in esophagectomy patients.

Main Methods:

  • Prospective recording of flushing, hemodynamic variables, and plasma 6-keto-PGF1α during the abdominal phase of open (n=25) and robotically assisted (n=25) esophagectomy.
  • Postoperative complications were assessed using the Clavien-Dindo classification.

Main Results:

  • Flushing occurred more frequently in open surgery (17/25) compared to robotically assisted surgery (5/25) (p=0.001).
  • Widespread (Grade II) flushing correlated with vasopressor use in the first hour of open surgery (p=0.036).
  • Patients experiencing flushing showed increased heart rate and plasma 6-keto-PGF1α (p<0.001). Severe postoperative complications were linked to Grade II flushing (p=0.037).

Conclusions:

  • Mesenteric traction syndrome is more prevalent during open esophagectomy than robotically assisted esophagectomy.
  • Severe mesenteric traction syndrome appears to be associated with increased postoperative complications after esophagectomy.
Keywords:
6-keto-PGF1αEsophagectomyflushingmesenteric traction syndromepostoperative complicationsvasopressor

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