Influence of the bronchial artery and the vagus nerve on hemodynamic and respiratory changes following extended radical lymphadenectomy with esophagectomy.

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Extended radical lymphadenectomy has severe influence on the cardio-pulmonary function after esophagectomy, and frequently causes postoperative pulmonary complications. We have experimentally and clinically evaluated the efficacy of the preservation of the right bronchial artery and pulmonary branches of the right vagus nerve to prevent such complications.1. Preservation of the right bronchial artery prevented tracheal ischemia following cervical and upper mediastinal lymph node dissection in which the trachea had been isolated and devascularized.2. Preservation of the pulmonary branches of the right vagus nerve minimized pulmonary edema caused by cardiac failure following extended radical lymphadenectomy with esophagectomy. Pulmonary edema causes microatelectasis in the lung and increases the pulmonary shunt which is the most important factor leading to respiratory failure following esophagectomy.3. Preservation of the right bronchial artery and pulmonary branches of the right vagus nerve decreased the mortality rate after extended radical lymphadenectomy with esophagectomy for patients with an esophageal carcinoma, mainly due to such preservation minimizing cardiac and/or respiratory failure and preventing tracheal ischemia.