Pulmonary thromboembolism after surgery for esophageal cancer: Its features and prophylaxis

We attempt to clarify the problems of pulmonary thromboembolism (PTE), whic h occurs less frequently in Japan than in the West, regarding its special p erioperative management and prophylaxis for PTE after esophagectomy. We stu died 26 patients with PTE following esophagectomy; among 1023 patients with esophageal cancer between 1984 and 1997, The presence of embolism was conf irmed by pulmonary perfusion scintigraphy, The incidence, diagnosis, and ot her issues of PTE were all reviewed, The incidence of PTE was 2.5%, with pa tients showing a biphasic early and late onset. The main symptoms were dysp nea in 19 patients and tachycardia in 17. Scintigraphy demonstrated 154 les ions, 35.7% of which were located in the left lower lobe and 25.3% in the r ight lower lobe, Treatment mainly consisted of the administration of hepari n and urokinase, Four of the 26 patients died. Intermittent pneumatic compr ession (IPC) with the administration of heparin has been used in our depart ment since 1994 to prevent PTE and this has also helped to decrease the inc idence from 3.2% to 0.7%, Because the incidence of PTE following esophagect omy is higher than expected, PTE should be considered whenever hypoxemia of some unknown cause is found, Both early diagnosis and treatment are essent ial. It is also important to prevent PTE by the use of IPC.