Pulmonary complications after subtotal oesophagectomy

Area of Science:

• Thoracic surgery
• Surgical oncology
• Pulmonary complications

Background:

• Subtotal oesophagectomy for intrathoracic oesophageal carcinoma carries a risk of postoperative pulmonary complications.
• Comparing outcomes between different surgical periods can reveal improvements in patient management.
• Previous outcomes indicated a significant mortality rate associated with pulmonary complications.

Purpose of the Study:

• To compare the incidence and mortality of postoperative pulmonary complications in patients undergoing subtotal oesophagectomy for oesophageal carcinoma between two distinct periods (1981-1983 and 1984-1986).
• To identify factors contributing to changes in pulmonary complication rates and outcomes.

Main Methods:

• Retrospective comparison of 50 patients (25 per period) who underwent subtotal oesophagectomy for intrathoracic oesophageal carcinoma.
• Analysis of postoperative pulmonary complications and mortality rates.
• Review of surgical techniques, anaesthesia, and postoperative care protocols.

Main Results:

• The mortality rate due to postoperative pulmonary complications decreased from 16% in 1981-1983 to 0% in 1984-1986.
• While the incidence of pulmonary complications was lower in the later period, the difference was not statistically significant.
• More extensive lymphadenectomies were performed in the later period without increasing mortality.

Conclusions:

• The adoption of specific surgical and anaesthetic strategies, alongside enhanced postoperative care, significantly reduced mortality from pulmonary complications after oesophagectomy.
• Key contributing factors included the posterior mediastinal route, selective endobronchial intubation with epidural anaesthesia, fluid restriction, early mobilization, and expectorant use.
• These combined interventions demonstrate a successful approach to mitigating critical pulmonary risks in oesophageal cancer surgery.