Abstract
Esophagectomy for esophageal cancer is one of the most invasive procedures in gastrointestinal surgery. An invasive surgical procedure causes postoperative lung injury through the surgical procedure and one‐lung ventilation during anesthesia. Lung injury developed by inflammatory response to surgical insults and oxidative stress is associated with pulmonary morbidity after esophagectomy. Postoperative pulmonary complications negatively affect the long‐term outcomes; therefore, an effort to reduce lung injury improves overall survival after esophagectomy. Although significant evidence has not been established, various pharmacological treatments for reducing lung injury, such as administration of a corticosteroid, neutrophil elastase inhibitor, and vitamins are considered to have efficacy for pulmonary morbidity. In this review we survey the following topics: mediators during the perioperative periods of esophagectomy and the efficacy of pharmacological therapies for patients with esophagectomy on pulmonary complications.
Highlights
Esophageal cancer is one of the major causes of cancer mortality worldwide, with more than 473,000 new cases and 436,000 deaths annually.[1]
Esophagectomy for esophageal cancer plays an important role in the strategy for curative treatment, but is associated with considerable morbidity and mortality.2-4 Morbidity after esophagectomy is significantly correlated with poor prognosis and especially pulmonary and infectious morbidities affected for long-term outcomes.5-8 Several studies revealed that postoperative pulmonary complications may be an independent predictor of poor long-term survival in patients undergoing resection of esophageal cancers.[5,6,8]
Among recent advances in the perioperative multidisciplinary treatments for the prevention of pulmonary complication,[9,10] we focus on pharmacological treatment and discuss immunological mechanisms related to lung injury caused by esophagectomy in this narrative review
Summary
Esophageal cancer is one of the major causes of cancer mortality worldwide, with more than 473,000 new cases and 436,000 deaths annually.[1]. The presence of a corticosteroid is considered to reduce lung injury by reducing these inflammatory and oxidative responses.[56] It was reported that corticosteroids had no effect on serum cytokines already released.[57] a corticosteroid was mainly administrated preoperatively or at the induction of anesthesia, which was reported to reduce postoperative IL-6 levels and the incidence of peripheral leukocytopenia caused by surgical stress.[58] Based on these theoretical mechanisms, the perioperative corticosteroid for patients with transthoracic esophagectomy was conventionally administered to improve mortality and pulmonary complications in Asia, especially in Japan. A well-known inhalant for the treatment of lung injury, was considered to decrease pulmonary artery pressure and improve oxygenation, but has not shown efficacy for ARDS
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