The effects of lung resection on physiological motor activity of the oesophagus†

Abstract

OBJECTIVES:To assess the modifications of oesophageal function after major lung resection and whether these modifications are correlated with the extent of resection ( pneumonectomy vs others). METHODS:In the last 5 years, 40 consecutive surgical patients with lung cancer were prospectively enrolled and divided in two groups: Group A (n = 20) patients scheduled for elective pneumonectomy and Group B (n = 20) for more limited resections (lobectomy or bilobectomy). In addition to routine evaluations, all patients underwent preoperative (within 5 days) and postoperative (6 months) oesophageal manometry to assess the lower oesophageal sphincter (LES), the oesophageal body and the upper oesophageal sphincter functions. Symptoms scoring questionnaires were recorded for each patient and the oesophageal dislocation assessed by radiological examinations.RESULTS: Thirty-three (15 of Group A and 18 of Group B) patients completed the study. After operation, we found that LES resting pressure was significantly lower in Group A compared with Group B (P = 0.01); conversely, the relaxing pressure resulted as being higher in Group A than in Group B (P = 0.01). In Group A compared with Group B, a significant reduction of amplitude and that of wave duration of oesophageal contractions were seen at the upper (0.0001 and 0.02, respectively), middle (0.0003 and 0.002, respectively) and lower (0.0001 and 0.0004, respectively) oesophageal body. In addition, 12 of 15 (80%) patients of Group A and 3 of 18 (17%) of Group B presented a lack of regular peristaltic movement (P = 0.001). Despite chest CT scan showing a shift of the oesophagus in 11 of 15 (73%) and 2 of 18 (11.1%) patients of Groups A and B (P = 0.001), the oesophagus dislocation resulted 'severe' on barium swallow study in only two patients of Group A. The manometric alterations were subclinical; heartburn was recorded in three patients (two of Group A and one of Group B) and epigastric pain in four (two for each group). No other symptoms were observed.CONCLUSIONS: Pneumonectomy may cause significant oesophageal motility disorders that are mostly subclinical. Thus, this type of surgery should not be denied to patients if required to treat their cancer.

Impact of thoracic surgery on esophageal motor function—Evaluation by high resolution manometry

“…Basseri et al observed a 6-fold increased risk for esophageal peristaltic dysfunction in lung transplant patients compared with healthy subjects (19). This is in line with data provided by Fiorelli and co-workers, who confirmed that pneumonectomy may cause significant EMD with reduction in LES resting pressure, especially when compared to lesser resections (20). Interestingly this did not The results are given as median including the range.…”

Extended Bronchoplasty Anastomosed between the Left Main and the Superior Segmental Bronchi for Locally Advanced Left Upper Lobe Lung Cancer with Invasion of the Basal Segment

“…Furthermore, only the superior segment prevented a rapid mediastinal shift and did not cause serious complications, such as postpneumonectomy syndrome or dysphagia. 7) This unique technique that avoids pneumonectomy is quite useful for preserving the patient's long-term quality of life after surgery.…”

Changes in esophageal physiology after paraesophageal hernia repair and Collis gastroplasty

“…However, if poorly prepared, the presence of gastric mucosa above a fundoplication may result in continued acid exposure with resultant symptoms of reflux. Previous studies have shown that thoracic and abdominal surgeries can alter esophageal motility and physiology which can lead to adverse post-surgical outcomes [7,8]. Recent studies on objective changes in esophageal motility and acid exposure after Collis gastroplasty in patients undergoing PEH repair is lacking.…”