Severe Postoperative Complications may be Related to Mesenteric Traction Syndrome during Open Esophagectomy

Abstract

Background: During abdominal surgery, traction of the mesenterium provokes mesenteric traction syndrome, including hypotension, tachycardia, and flushing, along with an increase in plasma prostacyclin (PGI₂). We evaluated whether postoperative complications are related to mesenteric traction syndrome during esophagectomy.

Methods: Flushing, hemodynamic variables, and plasma 6-keto-PGF_1α were recorded during the abdominal part of open ( n = 25) and robotically assisted ( n = 25) esophagectomy. Postoperative complications were also registered, according to the Clavien-Dindo classification.

Results: Flushing appeared in 17 (open) and 5 (robotically assisted) surgical cases ( p = 0.001). Mean arterial pressure was stable during both types of surgeries, but infusion of vasopressors during the first hour of open surgery was related to development of widespread (Grade II) flushing ( p = 0.036). For patients who developed flushing, heart rate and plasma 6-keto-PGF_1α also increased ( p = 0.001 and p < 0.001, respectively). Furthermore, severe postoperative complications were related to Grade II flushing ( p = 0.037).

Conclusion: Mesenteric traction syndrome manifests more frequently during open than robotically assisted esophagectomy, and postoperative complications appear to be associated with severe mesenteric traction syndrome.

Keywords: 6-keto-PGF1α; Esophagectomy; flushing; mesenteric traction syndrome; postoperative complications; vasopressor.