The effect of the surgical approach on respiratory function after oesophageal resection

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Abstract
Respiratory function has been studied in 32 consecutive patients having oesophageal resection to determine the overall pattern and to compare the effect on it of two standard surgical approaches. Eighteen patients had a left thoraco-laparotomy and 14 a laparotomy and separate right thoracotomy. The two groups were similar in age, sex, chest symptoms and smoking habits. The average operative time and amount of blood transfused were almost identical. Arterial PO2 and PCO2 were determined before surgery and on the first and third postoperative days. Spirometry was done preoperatively and on the thirteenth day after operation. Before operation respiratory function was similar in the two groups. On the first postoperative day both groups showed a pronounced fall in arterial PO2, with partial recovery on the third day. This recovery was significantly greater in the double incision group (t = 2·64, P < 0·02). Mean PCO2 levels altered less markedly, there being a small rise on the first day, with a fall to below normal on the third. There was no difference between the groups in PCO2. Vital capacity and I-second expiratory volume were reduced on the thirteenth day in both groups, but without a significant difference between the groups. Two patients died of pulmonary embolism, but the others recovered satisfactorily. It is concluded that: There is pronounced hypoxaemia in the first few days after oesophageal resection in the majority of patients. This is consistent with a satisfactory clinical state.The double incision laparotomy and right thoracotomy approach affects respiratory function less than left thoraco-laparotomy. When technically feasible it may be preferable in patients with respiratory impairment.