Pulmonary Edema Induced by Esophagectomy

Esophageal cancer is the seventh leading cause of cancer deaths worldwide (410,000 new cases annually)(1). Asian, Middle Eastern, and East African countries have a markedly higher incidence of esophageal cancer than other areas. In the United States, the incidence of adenocarcinoma of the distal esophagus and gastroesophageal junction has progressively increased to approximately 70% of all esophageal cancers over the last two decades. It affects mostly Caucasian men, and its pathogenesis is linked to gastroesophageal reflux disease (GERD) and the development of Barrett’s esophagus. On the other hand, squamous cell carcinoma is responsible for 95% of all esophageal cancers worldwide. It arises from whole esophagus, from the cervical esophagus to the gastroesophageal junction, and spreads to the cervical, thoracic, and abdominal lymph nodes with relative ease because of the abundant and complex lymphatic network (2). Therefore, esophagectomy with extensive neck, thoracic, and abdominal lymph node dissection, the so-called “3-field lymph node dissection,” is needed for curative surgery for esophageal squamous cell carcinoma (3). Though chemotherapy, radiotherapy, and combination therapy of both have been substantially developed as treatments for esophageal squamous cell carcinoma in recent years, these treatments are still inferior in survival rate and late toxicity compared to surgery (4).