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Pulmonary thromboembolism after surgery for esophageal cancer: Its features and prophylaxis

Surgery Today volume 30, pages 416–420 (2000)Cite this article

Abstract

We attempt to clarify the problems of pulmonary thromboembolism (PTE), which occurs less frequently in Japan than in the West, regarding its special perioperative management and prophylaxis for PTE after esophagectomy. We studied 26 patients with PTE following esophagectomy among 1023 patients with esophageal cancer between 1984 and 1997. The presence of embolism was confirmed by pulmonary perfusion scintigraphy. The incidence, diagnosis, and other issues of PTE were all reviewed. The incidence of PTE was 2.5%, with patients showing a biphasic early and late onset. The main symptoms were dyspnea in 19 patients and tachycardia in 17. Scintigraphy demonstrated 154 lesions, 35.7% of which were located in the left lower lobe and 25.3% in the right lower lobe. Treatment mainly consisted of the administration of heparin and urokinase. Four of the 26 patients died. Intermittent pneumatic compression (IPC) with the administration of heparin has been used in our department since 1994 to prevent PTE and this has also helped to decrease the incidence from 3.2% to 0.7%. Because the incidence of PTE following esophagectomy is higher than expected, PTE should be considered whenever hypoxemia of some unknown cause is found. Both early diagnosis and treatment are essential. It is also important to prevent PTE by the use of IPC.

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Affiliations

  1. Department of Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, 105-8470, Tokyo, Japan

    Kenji Tsutsumi, Harushi Udagawa, Yoshihiro Kinoshita, Masaki Ueno, Toyohide Nakamura & Hiroshi Akiyama

  2. First Department of Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Yoshiaki Kajiyama & Masahiko Tsurumaru

Authors
  1. Kenji Tsutsumi
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  2. Harushi Udagawa
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  3. Yoshiaki Kajiyama
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  4. Yoshihiro Kinoshita
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  5. Masaki Ueno
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  6. Toyohide Nakamura
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  7. Masahiko Tsurumaru
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  8. Hiroshi Akiyama
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Tsutsumi, K., Udagawa, H., Kajiyama, Y. et al. Pulmonary thromboembolism after surgery for esophageal cancer: Its features and prophylaxis. Surg Today 30, 416–420 (2000). https://doi.org/10.1007/s005950050614

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  • DOI: https://doi.org/10.1007/s005950050614

Key Words

  • pulmonary thromboembolism
  • esophageal cancer
  • postoperative complications
  • intermittent pneumatic compression