J.Jpn. Surg. Soc.. 88(3): 273-282, 1981

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Original article

RESPIRATORY FUNCTION AND PULMONARY THROMBOXANE RELEASE AFTER TOTAL THORACIC ESOPGAGECTOMY

In experimental studies using mongrel dogs, 60 minutes after total thoracic esophagectomy the dog lung transiently released into the systemic circulation up to about 6000μg/ml of thromboxane A₂ (TXA₂) measured by radioimmunoassay as its metabolite thromboxane B₂ (TXB₂). To determine whether lung TX release had effects on pulmonary function, we measured the changes in extravascular lung water (EVLW), lung resistance (R_L) before, 10, 30, and 60 minutes after total thoracic esophagectomy in 14 anesthetized dogs. In seven untreated dogs, EVLW and R_L increased and C_L decreased approximately twofold at 60 minutes after the surgery, which corresponded well with a large transpulmonary plasma concentration gradient of TXB₂. In remaining 7 dogs pretreated with intravenous OKY-046 which wasTXA₂ synthetase inhibitor, increase in EVLW and RL and decrease in CL were minimal and plasma concentration of TXB₂ remained low value of a preoperative level.
In clinical studies, 20 patients with esophageal carcinoma were evaluated. All of these patients underwent total thoracic esophagectomy with extended lymph node dissection of a similar extent. In 5 control patients, significant increase in EVLW and pulmonary vascular resistance were noted at 60 minutes after surgery. On the other h hand, while the patients who had intravenous OKY-046 administration during operation at a dose of 1μg/kg/min or 5μg/kg/min showed significant decrease in EVLW and pulmonary vescular resistance at 60 minutes after surgery.
Based on these results, it is concluded that TXA₂ appears to be one of the most important factors to cause the postoperative pulmonary complication after total thoracic esophagectomy for esophageal cancer.

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