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The journal «ONCOSURGERY» 2013, Vol.5, No 1

Prevention of postoperative pulmonary complications in patients with cancer of the esophagus and gastric cardia

Vashakmadze LA, Khomyakov VM, Volkova EE

PA Herzen Moscow Cancer Research Institute, Moscow, Russia
Contact: Khomyakov Vladidmir Mikhailovich, e-mail:

Purpose: to improve immediate results of surgical treatment of patients with cancer of the esophagus and cardia of stomach through the development of prevention measures of postoperative pulmonary complications (PPC).

Materials and methods. Main risk factors for the PPC were identified, measures for their prevention was devided. Risk factors for PPC were divided in two groups: 1) caused by initial condition of the patient and 2) caused by the type of surgery. The protocol of PPC prevention was developed.

It included:

  1. respiratory therapy;
  2. patient education and breathing exercises;
  3. sparing technique of the operation;
  4. optimization of anesthesia;
  5. prevention of aspiration;
  6. early activation of patients after surgery;
  7. pain control;
  8. nutritional support.

Results. The developed protocol was implemented on 30 patients with thoraco-abdominal tumors. Preoperative preparation was 10-14 days. Surgery was performed via combined approach, including laparatomy and right thoracotomy in all cases. Control retrospective group included 50 patients with similar surgery volume, which were carried out by standard preoperative preparation. In study group complications were registered in 12 patients (40%), there were no fatal outcomes. In the control group postoperative complications were observed in 28 patients (48%), including pneumonia – 30%, ARDS – 3 (6%), PE – 2 (4%), acute cardiovascular failure – 7 (14%), arrhythmia – 6 (12%), four patients died. Note decrease in the severity and number of complications, such as the absence of such serious complications as pulmonary embolism and respiratory distress syndrome.

Conclusion. The developed protocol of preparing patients and prevention of postoperative bronchopulmonary complications allows to reduce postoperative complication rates and mortality significantly.

KEY WORDS: esophageal cancer, postoperative pulmonary complications, complication prevention.


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