Pulmonary complications following esophageal surgery. Significance of aspiration

: Objective of this study was to show the different causes and the importance of pulmonary complications after esophageal surgery and their management by general and intensive care measures. In the University Hospital for General and Abdominal Surgery of Mainz 222 patients were treated for esophageal cancer from 9/1985 to 5/1997. Data of 214 patients were available for this investigation. In 65 cases a transhiatal dissection (blunt dissection) and in 149 patients a abdomino-thoracic dissection were performed. 54 (25.2%) patients had to be reintubated. 30-day lethality was 7.9% (n = 17) and hospital lethality was 13.1% (n = 28). 82 (38.3%) patients developed pulmonal dysfunction (pneumonia) which was aggravated by a following ARDS in 16 patients (19.5%). 21 (25.6%) of these patients died. In only 24 (29.3%) patients an isolated pneumonia occurred without evidence of general or surgical complications. In 65 of 82 patients further microbiologically examinations were documented. In 39 (60%) cases gastrointestinal bacteria were found. Therefore aspiration or microaspiration respectively are considered to co-cause pulmonary complications. Postoperative psychosyndrome, recurrent nerve palsy and ASA-risk stratification were accompanied by elevated rates of pneumonia. Careful selection of patients for esophageal resection, atraumatic surgical technique and reduction of general and surgical complications and intensive care measures can help to avoid postoperative pulmonary complications. Reduction of mediators activated by surgical trauma is not feasible so in the moment prevention of aspiration seems to be the most effective therapy in the postoperative course.