Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid

Masaru Morita, R. Yoshida, K. Ikeda, A. Egashira, Eiji Oki, N. Sadanaga, Y. Kakeji, Y. Ichiki, K. Sugio, K. Yasumoto, Yoshihiko Maehara

Research output: Contribution to journalArticle

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Abstract

Acute lung injury (ALI) is one of most serious complications to occur after an esophagectomy for esophageal cancer. However, the pathogenesis of ALI is still unclear. The cytokine levels of pleural drainage fluid as well as peripheral blood were measured in 27 patients who had undergone an extended radical esophagectomy. Both the clinical factors and cytokine levels were compared between 11 patients with (group I) and 16 without ALI (group II). ALI occurred more frequently in patients who underwent colon interposition than in those who received a gastric tube reconstruction (86% vs 25%, P = 0.009). The operation time of group I was significantly longer than that of group II. A logistic regression analysis revealed colon interposition to be an independent factor associated with the ALI (P < 0.05). Postoperative anastomotic leakage and systemic inflammatory response syndrome (SIRS) occurred more frequently in group I than in group II (P < 0.01). Both the serum interleukin-6 (IL-6) and IL-8 levels of group I were significantly higher than those of group II. IL-1β and tumor necrosis factor-α were undetectable in the peripheral blood, whereas they were detectable in the pleural effusion. The IL-1β of pleural effusion was higher in group I than group II. In conclusion, greater surgical stress, such as a longer operative time, is thus considered to be associated with the first attack of ALI. The adverse events developing in the extra-thoracic site, such as necrosis and local infection around anastomosis may therefore be the second attack. Furthermore, ALI may cause not only SIRS but also other complications such as anastomotic leakage.

Original languageEnglish
Pages (from-to)30-36
Number of pages7
JournalDiseases of the Esophagus
Volume21
Issue number1
DOIs
Publication statusPublished - Feb 1 2008

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Esophagectomy
Acute Lung Injury
Esophageal Neoplasms
Drainage
Cytokines
Systemic Inflammatory Response Syndrome
Anastomotic Leak
Pleural Effusion
Interleukin-1
Colon
Operative Time
Interleukin-8
Interleukin-6
Stomach
Necrosis
Thorax
Tumor Necrosis Factor-alpha
Logistic Models
Regression Analysis
Infection

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid. / Morita, Masaru; Yoshida, R.; Ikeda, K.; Egashira, A.; Oki, Eiji; Sadanaga, N.; Kakeji, Y.; Ichiki, Y.; Sugio, K.; Yasumoto, K.; Maehara, Yoshihiko.

In: Diseases of the Esophagus, Vol. 21, No. 1, 01.02.2008, p. 30-36.

Research output: Contribution to journalArticle

Morita, Masaru ; Yoshida, R. ; Ikeda, K. ; Egashira, A. ; Oki, Eiji ; Sadanaga, N. ; Kakeji, Y. ; Ichiki, Y. ; Sugio, K. ; Yasumoto, K. ; Maehara, Yoshihiko. / Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid. In: Diseases of the Esophagus. 2008 ; Vol. 21, No. 1. pp. 30-36.
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AU - Morita, Masaru

AU - Yoshida, R.

AU - Ikeda, K.

AU - Egashira, A.

AU - Oki, Eiji

AU - Sadanaga, N.

AU - Kakeji, Y.

AU - Ichiki, Y.

AU - Sugio, K.

AU - Yasumoto, K.

AU - Maehara, Yoshihiko

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N2 - Acute lung injury (ALI) is one of most serious complications to occur after an esophagectomy for esophageal cancer. However, the pathogenesis of ALI is still unclear. The cytokine levels of pleural drainage fluid as well as peripheral blood were measured in 27 patients who had undergone an extended radical esophagectomy. Both the clinical factors and cytokine levels were compared between 11 patients with (group I) and 16 without ALI (group II). ALI occurred more frequently in patients who underwent colon interposition than in those who received a gastric tube reconstruction (86% vs 25%, P = 0.009). The operation time of group I was significantly longer than that of group II. A logistic regression analysis revealed colon interposition to be an independent factor associated with the ALI (P < 0.05). Postoperative anastomotic leakage and systemic inflammatory response syndrome (SIRS) occurred more frequently in group I than in group II (P < 0.01). Both the serum interleukin-6 (IL-6) and IL-8 levels of group I were significantly higher than those of group II. IL-1β and tumor necrosis factor-α were undetectable in the peripheral blood, whereas they were detectable in the pleural effusion. The IL-1β of pleural effusion was higher in group I than group II. In conclusion, greater surgical stress, such as a longer operative time, is thus considered to be associated with the first attack of ALI. The adverse events developing in the extra-thoracic site, such as necrosis and local infection around anastomosis may therefore be the second attack. Furthermore, ALI may cause not only SIRS but also other complications such as anastomotic leakage.

AB - Acute lung injury (ALI) is one of most serious complications to occur after an esophagectomy for esophageal cancer. However, the pathogenesis of ALI is still unclear. The cytokine levels of pleural drainage fluid as well as peripheral blood were measured in 27 patients who had undergone an extended radical esophagectomy. Both the clinical factors and cytokine levels were compared between 11 patients with (group I) and 16 without ALI (group II). ALI occurred more frequently in patients who underwent colon interposition than in those who received a gastric tube reconstruction (86% vs 25%, P = 0.009). The operation time of group I was significantly longer than that of group II. A logistic regression analysis revealed colon interposition to be an independent factor associated with the ALI (P < 0.05). Postoperative anastomotic leakage and systemic inflammatory response syndrome (SIRS) occurred more frequently in group I than in group II (P < 0.01). Both the serum interleukin-6 (IL-6) and IL-8 levels of group I were significantly higher than those of group II. IL-1β and tumor necrosis factor-α were undetectable in the peripheral blood, whereas they were detectable in the pleural effusion. The IL-1β of pleural effusion was higher in group I than group II. In conclusion, greater surgical stress, such as a longer operative time, is thus considered to be associated with the first attack of ALI. The adverse events developing in the extra-thoracic site, such as necrosis and local infection around anastomosis may therefore be the second attack. Furthermore, ALI may cause not only SIRS but also other complications such as anastomotic leakage.

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