J.Jpn. Surg. Soc.. 79(11): 1426-1440, 1978

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Original article

STUDIES ON POSTOPERATIVE CARDIOPULMONARY HEMODYNAMICS IN PATIENTS WITH ESOPHAGEAL CANCER AS EVALUATED FROM VARIOUS RECONSTRUCTIVE PROCEDURES

Pre- and postoperative changes in cardiopulmonary hemodynamics in a series of 65 patients with esophageal cancer were studied by using Swan-Ganz Folw Directed Balloon Tipped Catheter on the basis of various esophageal reconstructive procedures with special reference to postoperative hypoxemia in 45 cases in which postoperative courses were uneventful.
1) In the group of total thoracic esophagectomy, postoperative gradual rises of pulmonary artery pressure (PAP) and gradual increases of both cardiac output (C.O) and urine volume were observed untill 3rd postoperative day. A-aDo₂ & Qs/Qt (true shunt) increased remarkably from 1st POD and to the maximum on 3rd POD. On the other hand PaO₂ decreased untill 3rd POD.
2) In the group of low thoracic esophagectomy, the changes of postoperative hemodynamics in terms of PAP, C.O., urine volume, A-aDo₂, Qs/Qt and PaO₂ were less than those in the group of total thoracic esophagectomy.
3) It seems that the differences o f postoperative hemodynamics between the two groups were primarily due to the degree of surgical stress attributable to surgical intervention to the superior mediastinum.
4) In both of the groups, intensive respiratory support was indicated in the cases in whcih Qs/Qt increased more than 15% and A-aDo₂ exceeded 250 mmHg.
5) In the cases in which early postoperative left ventricular function decremented remarkably as compared with the preoperative one, subsequent changes in the pulmonary hemodynamics were conspicuous which necessitated circulatory and respiratory care.

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