[Postoperative pulmonary complication and surgical treatment of esophageal cancer in aged patients--evaluation of preoperative risk factors and postoperative management].

Because of the recent improvement in surgical technique and perioperative management, surgical treatment for esophageal cancer has become more extensive and thus even aged poor-risk patients can be operated on. However, transthoracic esophagectomy is still associated with a high rate of postoperative pulmonary complications. We analysed the preoperative findings and postoperative treatment in aged patients. During the decade starting from 1980, 151 patients with esophageal cancer were admitted to our clinic, there were 44 aged patients over 70 years. They were examined for preoperative risk factors associated with multiple organ functions. Our special attention was paid to postoperative pulmonary complications and hemodynamics that were monitored using the Swan-Ganz catheter. In the aged patients, there were highly abnormal finding in preoperative examinations, especially in cardiac, pulmonary and renal functions. Moreover, their cardiac index levels were lower and pulmonary vascular resistance levels were higher than those of the younger group. Postoperative pulmonary complications were induced frequently in the poor-risk patients who underwent transthoracic esophagectomy. However, the patients who were received infusion of dopamine and dobutamine were able to keep hemodynamic balance in the early postoperative period. Most patients with esophageal cancer are relatively old and have often multiorgan dysfunction. Transhiatal esophagectomy is a safe operation that is suitable for the treatment of aged poor-risk patients who can not tolerate thoracotomy. Choice of a surgical procedure for them should be carefully determined according to the systemic preoperative assessment of risk factors. Postoperative fluid therapy and respiratory management should be performed more strictly in the aged patient.