Surgical therapy of esophageal carcinoma: the influence of surgical approach and esophageal resection on cardiopulmonary function

OBJECTIVE: The effects of the different surgical approaches (transhiatalesophagectomy and right-sided transthoracic esophagectomy) on perioperativecardiopulmonary function in the surgical treatment of esophageal carcinomaare discussed controversially and have not yet been evaluated. METHODS: Ina prospective randomized study including 32 patients, we investigated theeffects of the surgical approach (blunt dissection (n = 16) versustransthoracic en-bloc resection (EB) (n = 16)) in the treatment ofesophagus carcinoma on perioperative cardiopulmonary function. Thefollowing parameters were measured in all patients: cardiac index (CI),mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonaryartery pressure (MPAP), pulmonary capillary wedge pressure (PCWP),intrapulmonary shunt (QS/QT), arterio- alveolar (aaDO2), arterio-venousoxygen pressure difference (avDO2), and blood gas analyses. Time ofmeasurement were: after induction of anesthesia, beginning and end ofesophagus resection, end of surgery, 1 h postoperatively, and then every 12h until the third postoperative day. RESULTS: Compared to blunt dissection,en-bloc esophagectomy was found to be associated with a transientdeterioration of pulmonary function during one-lung ventilation in theleft-lateral position, which could already be compensated for during theintervention. No other significant differences in cardiopulmonary effectswere seen between the two surgical techniques. The incidence ofpostoperative complications was identical in both groups. CONCLUSIONS: Theresults of our study show that en-bloc resection is only associated with anincreased intraoperative pulmonary strain that is completely compensatedduring the operation and that there is no difference in cardiopulmonaryfunctions between the two techniques in the postoperative course.