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開催概要
開催回
第58回・2020年・京都
 

食道切除術後における多量胸水症例のリスク因子の同定

演題番号 : WS18-2

[筆頭演者]
松本 知拓:1 
[共同演者]
菊池 寛利:1、羽田 綾馬:1、曽根田 亘:1、川田 三四郎:1、廣津 周:1、平松 良浩:1,2、神谷 欣志:1、森田 剛文:1、竹内 裕也:1

1:浜松医科大学・外科、2:浜松医科大学・周術期等生活機能支援学

 

Background: Postoperative massive pleural effusion (MPE) may decrease nutrition status and increase the risk of infection in esophageal cancer patients undergoing esophagectomy. Chylothorax is a relatively rare postoperative complication, however, it remains difficult to treat. Although there is considerable controversies on the appropriate management strategies, recent reports showed the clinical efficacies of etilefrine for the postoperative chylothorax. In this study, we retrospectively analyzed risk factors for MPE after esophagectomy, and discuss the use of etilefline for the management of MPE.
Methods: This study enrolled 113 esophageal cancer patients who underwent esophagectomy at our institution between April 2017 and March 2020. Patients were divided into two groups; H (≧500 ml/day) and L (< 500 ml/day) according to the maximal volume of daily pleural effusion drained via the right chest tube, and clinicopathological data were compared between the groups.
Results: Median age was 69 y/o. Open thoracotomy, thoracoscopic surgery and robotic surgery was performed in 28, 64 and 21 patients, respectively. The number of patients with tumor depth ≧cT3 (P=0.013), those who underwent neoadjuvant therapy (P=0.001), open thoracotomy (P<0.001) and thoracic duct resection (P=0.002), and operation time (P=0.002), anesthesia time (P=0.004) and blood loss (P<0.001) were significantly higher in H group. Etilefrine was administrated in 8 patients in H group. Whereas lymphangiography was additionally performed in one patient, the use of etilefrine alone appeared to improve MPE in 7 patients without adverse events.
Conclusions: Neoadjuvant therapy and thoracic duct resection for advanced cancer were identified as risk factors for MPE. The early use of etilefrine is a safe and effective treatment option for the management of MPE.

キーワード

臓器別:食道

手法別:手術療法

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