Paraplegia after esophagectomy: Who are the patients at risk?

Abstract

mid-esophagus. The patient was noted to have paraplegia in the immediate postoperative period, a complication thought to be due to a noncompressive thoracic myelopathy, possibly caused by spinal cord ischemia. Clinical summary. A 52-year-old man with a history of diabetes mellitus, hypertension, and obesity was admitted to the University of Illinois Hospital 3 months after esophageal resection for carcinoma of the mid-esophagus performed elsewhere. The patient had a history of severe reflux esophagitis complicated by esophageal stricture and Barrett esophagus. He had been treated in the past with several dilatations. Because of symptoms of weight loss and dysphagia to solid food, he underwent an esophagogastroduodenoscopy that showed a sessile ulcerative lesion in the mid-esophagus. Biopsy specimens of that lesion showed a poorly differentiated adenocarcinoma. Subsequently, the patient underwent a subtotal esophagectomy and an intrathoracic esophagogastrostomy performed through a right lateral thoracotomy (Ivor Lewis approach). No perigas-Paraplegia after esophageal resection for carcinoma of the esophagus is rare. A review of the world literature since 1966 showed that only 4 such cases have been reported. [1][2][3] We add a fifth case, that of a patient who was referred to our institution for follow-up after resection of adenocarcinoma of the

Paraplegia following oesophagectomy

“…However, it is rare after pulmonary, tracheal or pleural surgery,2 , 3 with the overall incidence estimated to be 0.08% 1. Only five cases of paraplegia have been reported between 1966 and 2001 after oesophageal resection 2. The five cases previously described were performed on men in the 58–85 year age range who had advanced atherosclerotic disease and risk factors such as diabetes mellitus, hypertension and obesity.…”

Perioperative complications of esophagectomy - prevention, diagnosis and management

“…Iako patofiziologija nije u celini razjašnjena, smatra se da ona nastaje zbog neadekvatnog protoka kroz prednju spinalnu arteriju (ishemijska lezija). Do ovakve situacije može doaei usled podvezivanja interkostalnih arterija kojom prilikom je podvezana Adamkiewicz-eva arterija, hirurške manipulacije sa aortom kojom prilikom može doaei do odvaljivanja aterosklerotiènog plaka koji okludira radikularnu arteriju, hipotenzije tokom operacije (najèešaee zbog krvarenja), preterane upotrebe vazopresora 96 . Klinièka slika odgovara sindromu prednje spinalne arterije, varira zavisno od nivoa i opsega lezije, uz izražen motorni def i cit i prisutan ili ošteaeen senzibilitet.…”

Spinal cord ischemia following thoracotomy without epidural anesthesia

“…[9][10][11] Spinal cord ischemia is a wellknown complication of thoracic aortic surgery and aortic cross clamping, with disruption of segmental arterial supply to the cord. 2,9,12 Other potential factors include spinal cord procedures, spinal artery damage or embolization, coagulopathy, and global ischemia.…”

“…An MRI scan is far more sensitive in excluding potential causes such as spinal cord compression, or detecting other causes such as spinal cord ischemia. 3,11,16 There is no definitive treatment for spinal cord ischemia without cord compression. However, maintenance of spinal cord perfusion and oxygenation should be a clinical priority.…”