Abstract
It has been reported that, due to the severe surgical stress of thoracotomy, respiratory function after esophagectomy under thoracotomy worsened as late as a month after surgery. To investigate the mechanism of the reduction of the respiratory function, we utilized chest CT to analyze separately the changes in the lung volume of the thoracotomized side and the other side. Here, we reported the results of our comparative study of lung volume and respiratory function, which was performed by spirogram before esophagectomy and 6 months afterwards. We selected twenty-three patients who had undergone esophagectomy under right thoracotomy. Fourteen of the selectees received standard thoracotomy, while the other nine had the anterior serratus muscle and the latissimus dorsi muscle preserved. Total lung volume was found to have decreased from a preoperative value of 4077 ± 674 ml (mean ± SD) to a postoperative value of 3964 ± 774 ml, and right-lung volume significantly decreased from 2229 ± 397 to 2023 ± 397 ml, while left-lung volume tended to increase. While right-lung volume in standard thoracotomy displayed a significant decrease from 2264 ± 334 to 1949 ± 424 ml, that in muscle-preserving thoracotomy showed almost no change. Spirogram revealed that vital capacity had decreased from 3574 ± 601 to 2666 ± 576 ml, and forced expiratory volume in the first second showed a significant decrease from 2680 ± 500 to 2249 ± 485 ml. Comparing the decreasing rate, the correlation coefficients between right-lung volume and % VC was 0.58. These results suggested that a change of lung volume in the thoracotomized side could play a role in the post-operative decrease of vital capacity and that muscle-preserving thoracotomy might induce less surgical stress than standard thoracotomy.
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Ronald BP, Antoine F, Richard SD, Allan LT, Harold S. Comparison of late pulmonary function after posterolateral and muscle-sparing thoracotomy. Ann Thorac Surg 1992; 53: 675–9.
Kitamura M, Nishihira T, Hirayama M, Akaishi T, Shineha R, Sanekata K, et al. Changes in respiratory function in the late period after operation for esophageal cancer. Clinic and Study 1998; 66: 3467–71.
Sasaki K, Muto K, Tanaka O, Daikei H, Wakakuwa R, Ueki S. Respiratory function after esophagectomy for esophageal cancer. Thorac Cardiovasc Surg 1985; 33: 145–7.
Peters RM, Wellons HA Jr, Htwe TM. Total compliance and work of breathing after thoracotomy. J Thorac Cardiovasc Surg 1969; 57: 348–55.
Kitamura M, Nishihira T, Hirayama M, Kawauchi S, Kano M, Akaishi T, et al. Pulmonary complications after operation for carcinoma of the thoracic esophagus. — Analysis of the Cases During Past 10 Years —. J Gastrointestinal Surg 1987; 20: 2706–11.
Maeda F. Pulmonary function during exercise before and after radical esophagectomy for esophageal cancer. J Thorac Cardiovasc Surg 1997; 45: 1–11.
Stephen R, Rodney JL, Theresa MB, Marydeth P, Richard AS, Weerachai N, et al. The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain. J Thorac Cardiovasc Surg 1991; 101: 394–401.
Daniel MB, Carmack H. Muscle-sparing posterolateral thoracotomy. Ann Thorac Surg 1988; 45: 337–9.
Michael DH, Nelson A, John LO. Thoracotomy through the auscultatory triangle. Ann Thorac Surg 1989; 47: 782–3.
Robert LM. The lateral limited thoracotomy incision: standard for pulmonary operations. J Thorac Cardiovasc Surg 1990; 99: 590–6
Akaishi T, Shineha R, Oguri H, Endo Y, Miyata G, Sugawara K, et al. Thoracoscopy and thoracotomy — A comparison between the two different approaches to the esophagogastrectomy for esophageal cancer. JSES 1996; 1: 378–83.
Noda M, Ono S, Suzuki S, Chida M, Tabata T, Maeda S, et al. Effect of thoracoscopic procedure versus standard posterolateral/muscle-sparing thoracotomy on pulmonary lung function. Thorac Surg 1997; 50: 368–72.
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Maruyama, K., Kitamura, M., Izumi, K. et al. Postoperative lung volume calculated by chest computed tomography in patients with esophageal cancer. Jpn J Thorac Caridovasc Surg 47, 193–198 (1999). https://doi.org/10.1007/BF03217993
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DOI: https://doi.org/10.1007/BF03217993