Pharmacological treatment to reduce pulmonary morbidity after esophagectomy

Abstract

Esophagectomy for esophageal cancer is one of the most invasive procedures in gastrointestinal surgery. An invasive surgical procedure causes postoperative lung injury through the surgical procedure and one‐lung ventilation during anesthesia. Lung injury developed by inflammatory response to surgical insults and oxidative stress is associated with pulmonary morbidity after esophagectomy. Postoperative pulmonary complications negatively affect the long‐term outcomes; therefore, an effort to reduce lung injury improves overall survival after esophagectomy. Although significant evidence has not been established, various pharmacological treatments for reducing lung injury, such as administration of a corticosteroid, neutrophil elastase inhibitor, and vitamins are considered to have efficacy for pulmonary morbidity. In this review we survey the following topics: mediators during the perioperative periods of esophagectomy and the efficacy of pharmacological therapies for patients with esophagectomy on pulmonary complications.

Hydrogen-oxygen therapy improves postoperative pulmonary functions and accelerates recovery through attenuating inflammatory reactions and oxidative stress in patients undergoing lung surgery

“…One-lung ventilation technique was consistently used during the pulmonary surgery. Collapsing and re-expanding the lung can cause ventilation-perfusion mismatch and ischemia-reperfusion injury, which leads to the release of in ammatory cytokines and oxygen free radicals, with subsequent lung injury [30,31]. In the present clinical trial, patients in the control group had signi cantly increased in ammatory cytokines TNF-α and IL-6, whereas patients receiving hydrogen-oxygen therapy did not show postoperative changes.…”

Impact of Prophylactic Corticosteroid Use on In-hospital Mortality and Respiratory Failure After Esophagectomy for Esophageal Cancer

“…8 A previous RCT suggested that prophylactic corticosteroids may benefit high-risk surgical patients based on subgroup analysis. 6 Because esophagectomy carries a higher risk of respiratory failure than cardiac surgery 6,7 and other major noncardiac surgery, 9 possibly due to its invasiveness and 1-lung ventilation, 3 prophylactic corticosteroids carries the potential of reducing mortality following esophagectomy.…”

“…Prophylactic neutrophil elastase inhibitor use was defined as the use of a neutrophil elastase inhibitor on the day of surgery. Perioperative neutrophil elastase inhibitors have been considered for clinical use to attenuate lung injury associated with systemic inflammatory response syndrome after esophagectomy,3 similar to prophylactic administration of corticosteroids.…”

“…Surgical procedures induce local and systemic inflammation, and adequate inflammation reactions are necessary for tissue healing 2. However, highly invasive surgeries such as esophagectomy often cause excessive systemic inflammation response, which may lead to tissue damage and organ failure, especially respiratory failure 2,3. Therefore, there has been great interest in attenuating the perioperative systemic inflammatory response through the use of preoperative anti-inflammatory drugs (eg, corticosteroids) 4–9…”

Exploring the Modulatory Effect of High-Fat Nutrition on Lipopolysaccharide-Induced Acute Lung Injury in Vagotomized Rats and the Role of the Vagus Nerve

“…Since the vagus nerve is both involved in the CAIP and in regulating the aforementioned physiological functions in the lung through its pulmonary branches, the vagotomy may be an important factor in the development of pulmonary complications following esophagectomy. Although several factors have been associated with postoperative (pulmonary) complications [ 22 , 23 , 24 , 25 , 26 ], the exact pathogenesis is not fully understood [ 27 , 28 , 29 ]. As pulmonary complications often lead to a prolonged length of hospital and ICU stay, increased hospital and ICU readmission rate and even mortality, the role of the vagotomy in pulmonary complications and lung injury following esophagectomy could be important [ 13 , 30 , 31 , 32 ].…”