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

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