There are two major surgical procedures for excision of esophageal carcinoma and reconstruction of the esophagus: the one-stage procedure and the two-stage procedure. In the present study, we evaluated the two methods by comparing the cardiovascular, respiratory and immune parameters of 10 patients who underwent one-stage procedure with those of 10 other patients who underwent two-stage procedure. To estimate cardiovascular function, we measured the left ventricular stroke work index (LVSWI)-pulmonary capillary wedge pressure (PCWP). Most of the patients treated by the one-stage procedure showed a significant decrease in LVSWI-PCWP, whereas the index of patients treated by the two-stage procedure did not change much. When we assessed the respiratory system by forced vital capacity (FVC) and peak expiratory flow (PEF), the patients treated by the two-stage procedure recovered much faster and better than those receiving the one-stage procedure. Natural killer (NK) activity in lymphocytes was also measured as a marker of the immuno-reactive system. Although most patients show a drop in NK activity one week after major surgery, NK activity did not demonstrate a significant change in any of the patients who underwent the two-stage procedume. Thus, our systemic comparison of the three different parameters demonstrated better results after the two-stage procedure and we recommend it over the one-stage procedure, especially for aged and high risk patients.
intrathoracic esophageal carcinoma
reduction of operative stress