Pulmonary complications after esophageal surgery

Objective of this study was to show the different causes and the importance of pulmonary complications after esophageal surgery and their management b y general and intensive care measures. In the University Hospital for Gener al and Abdominal Surgery of Mainz 222 patients were treated for esophageal cancer from 9/1985 to 5/1997. Data of 214 patients were available for this investigation. In 65 cases a transhiatal dissection (blunt dissection) and in 149 patients a abdominothoracic dissection were performed. 54 (25.2%) pa tients had to be reintubated. 30-day lethality was 7.9% (n = 17) and hospit al lethality was 13.1% (n = 28). 82 (38.3%) patients developed pulmonal dys function (pneumonia) which was aggravated by a following ARDS in 16 patient s (19.5%). 21 (25.6%) of these patients died. In only 24 (29.3%) patients a n isolated pneumonia occurred without evidence of general or surgical compl ications. In 65 of 82 patients further microbiologically examinations were documented. In 39 (60%) cases gastrointestinal bacteria were found. Therefo re aspiration or microaspiration respectively are considered to co-cause pu lmonary complications. Postoperative psychosyndrome, recurrent nerve palsy and ASA-risk stratification were accompanied by elevated rates of pneumonia . Careful selection of patients for esophageal resection, atraumatic surgic al technique and reduction of general and surgical complications and intens ive care measures can help to avoid postoperative pulmonary complications. Reduction of mediators activated by surgical trauma is not feasible so in t he moment prevention of aspiration seems to be the most effective therapy i n the postoperative course.