J.Jpn. Surg. Soc.. 97(6): 421-426, 1996

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Feature topic

SURGICAL PROCEDURES AND INTRA-OPERATIVE MANAGEMNET TO PREVENT POSTOPERATIVE COMPLICATIONS FOLLOWING RESECTION OF ESOPHAGEAL CANCER

To prevent postoperative complications following resection of an esophageal cancer, the nerves and vessels ralated to the cardiopulmonary function should be preserved as far as possible. Preservation of the right bronchial artery, the pulmonary branches of the right vagus nerve, the thoracic duct, the azygos vein, the inferior thyroidal artery, and the paratracheal sheath decreases the incidence of pulmonary distress syndrome and of tracheobronchial ischemic Iesions. In patients whose vessels and nerves are resected together with a Iocally advanced tumor, reinforcement of the tracheal membrane using a gastric pedicle or lattisimus dorsi muscle flap, or a two-staged operation is recommended. So as not to injure the recurrent nerves, use of a tracheal retractor and taping of the left recurrent nerve are recommended. Also, the phrenic nerves should be found in the deep cervical fascia before dissection of the supraclavicular nodes and should be preserved.

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