Pulmonary complications after esophageal cancer surgery through right thoracic approach

In order to investigate the effect of preoperative pulmonary function exerted on the postoperative pulmonary complications, postoperative chest X-ray films were consecutively studied in terms of abnormal shadows in the lung up to the 30th postoperative day (p.o.d.) in a series of 60 patients with intrathoracic esophageal cancer. Patients were divided into 3 groups according to their preoperative % VC and FEV1.0%; patients with % VC greater than or equal to 100% and FEV1.0% greater than or equal to 80% were stratified as group A, those with % VC greater than or equal to 80% and FEV1.0% greater than or equal to 70% excluding group A as group B, and those with % VC less than 80% or FEV1.0% less than 70% as group C. Patients with pyothorax secondary to anastomotic leakage, and/or ARDS due to proven septicemia were excluded. Abnormal shadows on the chest X-ray were observed in 68.3% of all the patients after surgery. The positive ratios for those shadows were not statistically different among the three groups. Before 3rd p.o.d., preoperative pulmonary function did not correlate with the positive ratio for abnormal shadows of each group. After 5th p.o.d., however, the positive ratios in group C were higher than those in group A and B up to 14th p.o.d. (p less than 0.05). Approximately seventy per cent of all abnormal shadows started within 3 days after the operation. Abnormal shadows first appeared on the upper lung fields more frequently in group C than in group A + B (p less than 0.01). The abnormal shadows on the right lower lung field appeared significantly later than those on the right upper lung field (p less than 0.05). In group C, major abnormal shadows were found in 71.4%, which were higher than those in group A and B (p less than 0.05). The abnormal shadows in group C persisted for a period of 14 days, which was longer than those in group A and B (p less than 0.05). In conclusion, preoperative pulmonary function exerts much influence on the progress and continuity of abnormal shadows in the lung after 5th p.o.d. in patients with esophageal cancer.