J.Jpn. Surg. Soc.. 90(8): 1180-1185, 1989

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Original article

CLINICAL ANALYSIS OF POST-OPERATIVE HYPERBILIRUBINEMIA FOLLOWING RESECTION OF ESOPHAGEAL CANCER (PART II) THE INFLUENCES OF EXTENSIVE LYMPHATIC DISSECTION

The incidence of postoperative hyperbilirubinemia (PHB) in 30 cases of resected esophageal cancer with extensive lymphatic dissection was 87% (26 cases) since 1986. Patients with higher bilirubin (bil.) level (group A : bil.≧3.5) composed of 77% (23 cases). Both rates were significantly higher than that of PHB (59%) and that of group A (29%), respectively, in 1979ー1985 when extensive lymphatic dissection had not been performed. Patients with PHB had lower nutritional index and underwant longer postoperative mechanical ventilation in comparison to patients with normal bil. levels.
Addition of cholecystectomy or cholecystostomy to esophagectomy could not reduce the incidence of PHB. Plasma endotoxin was measured postoperatively in 9 cases, 6 of which showed postivie reaction. PHB was developed in 5 of 6 cases with positive plasma endotoxin.
Though PHB was accompanied by cholestasis, leukocytosis and postive plasma endotoxin, clear septic foci could not be identified. Therefore, infection with occult septic foci caused by excessive surgical stress may be the cause of endotoxemia and contributing to PHB.

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