[Pulmonary function during exercise before and after radical esophagectomy for esophageal cancer]

Since the postoperative long-term evaluation for thoracic esophageal carcinoma had not been sufficient by a conventional respiratory function test alone, investigation was carried out by observing the changes in motor tolerance. The subjects were selected of 50 cases who elapsed more than 3 months before and after the operation among the cases who had been undergone radical operations with right thoracotomy and laparotomy for thoracic esophageal carcinoma; and then all of the subjects were subjected to a conventional respiratory function test and a respiratory movement loading test. Furthermore, investigation by use of multivariate analysis (Quantification: Class 1) was conducted for the factors relating to the depression of respiratory movement. For loading the movement, bicycle-type ergometer were employed, and a graded gradual-increase loading method was adopted. With the general respiratory function test, vital capacity was depressed from a preoperative average value of 2.1 +/- 0.4 (1/m2) to a postoperative average value of 1.6 +/- 0.3 (1/m2) showing a depressing trend being significant to a postoperative condition (p < 0.0001), and no significant postoperative difference was observed for FEV 1.0%. Even in such a condition, no significant depression was observed for oxygen intake at resting, but the maximum oxygen intake showed a significant depression (p < 0.0001) from a preoperative average value of 22.3 +/- 5.0 to a postoperative average value of 19.3 +/- 4.1 ml/min/kg. The maximum carbon oxide evacuation showed a significant depression (p < 0.0001) after operation. The ventilation quantity in a course of movement showed a depressing trend after operation, with be number of respiration in an increasing trend, showing a shallow-but-quick respiratory pattern. Mobility restriction due to circulation factors was not observed, and also the nutrition before and after operation did not show any significant difference in the blood examination. But the lactic acid during movement showed a significant increase after operation. As described above, it is considered that a pattern of restrictive impairment at resting increased an oxygen equivalent resulted from depression of oxygen intake by the movement, an increase in dead space ventilation rate for minute ventilation at movement, and a shallow-but-quick respiratory pattern have caused aggravation of the ventilation efficiency, which finally led to the interruption of movement. In a long-term period, as clinical factors relating to those, cigarette smoking, nutrition before operation, age, and postoperative radiation therapy are concerned, which were thus considered the key factors in considering the postoperative long-term QOL. Nutrition and rehabilitation by continuous muscle training is necessary to improve the long-term QOL, after radical esophagectomy.