INFLUENCE OF THORACIC EPIDURAL ANALGESIA ON OUTCOME AFTER RESECTION FOR ESOPHAGEAL CANCER

Background. Many series have reported a lessening of the incidence of anastomotic dehiscence after thoracoabdominal resection of esophageal carcinomata. This has resulted in fatal respiratory complications assuming a relatively greater role as a cause of death after such procedures. This study was conducted to investigate the impact of the routine use of thoracic epidural analgesia on respiratory complications after resection for esophageal carcinoma. Methods. This incidence of respiratory complications and the effect on outcome were studied in two groups of patients undergoing thoracoabdominal esophagogastrectomy for esophageal cancer during a 15-year period. The first group comprised 81 patients who underwent operation from 1975 through 1985 in whom thoracic epidural analgesia was not used; the second group comprised 75 patients who underwent operation from 1985 through 1990 in whom thoracic epidural analgesia was used routinely. Results. In the latter group, the incidence of respiratory complications was 13%, and no fatal respiratory complications occurred, compared with corresponding figures of 30% and 5% in the nonepidural group. The 30-day/hospital mortality during the first period was 9.8% and 6.6% in the 75 patients in whom thoracic epidural analgesia was used routinely. Conclusions. The results of this study suggest that the routine use of thoracic epidural analgesia during thoracoabdominal esophagogastrectomy for esophageal cancer reduces the incidence of fatal and nonfatal respiratory complications and should be incorporated into routine surgical management of operable esophageal cancer.