Abstract: Due to complicated procedures and severe trauma, esophagectomy still remains an operation with high mortality and morbidity. With the advancement of anesthetic and surgical technique, as well as perioperative management, the mortality and morbidity after esophagectomy decreased significantly in recent years. The optimal perioperative management, normalized and individualized treatment was of importance in preventing postoperative complications and decreasing mortality after esophagectomy. This review summarizes the current state of perioperative management for esophagectomy.
Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy. Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007. Five patients suffered from neurogenic tumors, 4 patients apical lung carcinomas, and 1 patient apicoposterior lung tumor. The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae, carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line. The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward. Results There was no death in this group. Tumors in 9 patients were resected completely. Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs. Shoulder and back pain in 3 of 4 patients was remitted postoperatively. Two patients with “dumbell” neurogenic tumors improved strength of lower limbs. Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one. Two patients required thoracentesis because of complicating with pleural effusion. The mean followup period was 18 months (range 336). Seven of 10 patients still lead a normal life. Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely.
Objective To investigate the feasibility, curative effect and perioperative treatments of lobectomy for pulmonary diseases by complete videoassisted thoracoscopic surgery (VATS). Methods Fiftysix patients of pulmonary diseases were treated with thoracoscopic lobectomy (including mediastinal and hilar lymph node dissection for malignant diseases) from March 2006 to November 2007 in our Department. Twelve right upper lobectomy, three right middle lobectomy, fifteen right lower lobectomy, nine left upper lobectomy, fourteen left lower lobectomy and three bilobectomy were carried out. The bilobectomy included one right upper and middle lobectomy, two right middle and lower lobectomy. Mediastinal and hilar lymph node dissection was simultaneously performed in the malignant cases. The feasibility, safety and postoperative complications were retrospectively analyzed. Results Fiftytwo patients (92.8%) were performed successfully by complete VATS. The median operative duration and blood loss were respectively 107±29min(from 45min to 168min) and 121±32 ml(from 50ml to 310ml). The incision in two cases (3.6%) were elongated to around 8 cm, the ribs were retracted, and the operations were completed by the help of VATS. Another two patients (3.6%) were changed to conventional thoracotomy for pneumonectomy or hemostasis. The postoperative pathology diagnosis was lung cancer in thirty nine, tuberculoma in seven, inflammatory pseudotumor in four, indurative angioma in four, bronchiectasis in one and metastasic chondrosarcoma in one. There was no surgical mortality. One case suffered from atelectasis in the middle lobe postoperatively and was cured by phlegm suction with bronchoscopy. Two air leakage healed automatically in three days. No other severe complications was observed. The average postoperative hospitalization was 8.9±3.1 d(from 8 d to 14 d). Conclusion Lobectomy for pulmonary diseases by complete VATS is technically fieasible, safe, minimally invasive with less complications and fast rehabilitation.
Objective To investigate the effect of lung volume reduction surgery （LVRS） on messenger RNA expression levels of cytoskeletal proteins in diaphragmatic muscle tissues of emphysematous rabbits. Methods A total of 40 rabbits were randomly divided into 4 groups （10 rabbits in each group） ：normal control group, emphysema group, sham operation group and LVRS group. Rabbits in control group were intratracheally administered with 0.9% normal sodium, but those in other groups were intratracheally administered with 0.4% papain at the dose of 0.5 ml/kg and inhaled cigarette smoke to induce emphysema model. Then, rabbits in emphysema group were fed routinely, however, after median sternotomy , bilateral LVRS was performed in LVRS group but not in sham operation group. The mRNA expression levels of titin and nebulin in the diaphragmatic muscles of rabbits in each group were detected by reverse transcription-polymerase chain reaction（RT-PCR）. Results Compared with control group, the mRNA expression levels of titin and nebulin in the rabbit diaphragm of emphysema groups and sham operation group decreased significantly （P〈0.01 ）, so did those in LVRS group （P〈0.05）. But it increased significantly in LVRS group compared with emphysema group and sham operation group （P〈0.05）. Conclusion LVRS can increase the mRNA expression levels of titin and nebulin in diaphragmatic muscle tissues of emphysematous rabbits, which may be the associated mechanisms at the molecular level in restoring the functions of the emphysematous diaphragm by LVRS.
Objective To introduce the technique of esophageal intraluminal stenting and assess its effect on the prevention of development of stenosis in patients with esophageal burns. Methods Thirty-three patients were admitted less than 3 weeks after ingestion of caustic agents. The second-or third-degree injuries were confirmed by esophogoscopy in all cases, but one with esophageal perforation at admission. Esophageal stenting was performed in all patients and these stents were kept in place for 4 to 6 months. Results There was no death in the series. All patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow test. Follow-up from 1 to 60 months five cases developed esophageal stenosis from 2 to 3 months after extracting the stents. One of them responded to esophageal bougienage, the remaining 4 patients required esophageal reconstruction and took a normal diet postoperatively. The other 28 patients have a normal diet after the stent removal. Conclusion The esophageal intraluminal stenting is able to prevent the formation of stricture in the aftermath of esophageal burns and its effect will be enhanced plus administering isoniazid.
Objective To analyse postoperative complications and cause of death for carcinoma of esophagus. Methods A retrospective study was undertaken for data of 2 085 patients with esophageal carcinoma from 1963 to 2003, the patients were divided into group A (332 cases,1963-1983), group B(727 cases,1984-1993) and group C (1 026 cases,1994-2003) by time. The postoperative complications and cause of death were analysed. Results Resectability rate, incidence rate of postoperative complications and hospital mortality were 90.84%(1 894/2 085), 11.61% (242/2 085) and 1.82% (38/2 085) respectively. Main complications were pulmonary complications (3.93%,82/2 085),anastomotic leak (3.12%,59/1 894), and cardiovascular disease (1.29%,27/2 085). Resectability rate of group B and group C were higher than that of group A, incidence rate of postoperative complications and hospital mortality of group B and group C were lower than that of group A. Resectability rate of group C were higher than that of group B, incidence rate of postoperative complications except pulmonary complications and hospital mortality of group C were lower than those of group B. Conclusions Pulmonary complications and anastomotic leak are main postoperative complications and cause of hospital death for carcinoma of esophagus, they are decreasing in recent years because of the progress of anesthetic,surgical technique and perioperative management.