We attempt to clarify the problems of
pulmonary thromboembolism (PTE), which occurs less frequently in Japan than in the West, regarding its special perioperative management and prophylaxis for PTE after
esophagectomy. We studied 26 patients with PTE following
esophagectomy among 1023 patients with
esophageal cancer between 1984 and 1997. The presence of
embolism was confirmed by pulmonary perfusion scintigraphy. The incidence, diagnosis, and other issues of PTE were all reviewed. The incidence of PTE was 2.5%, with patients showing a biphasic early and late onset. The main symptoms were
dyspnea in 19 patients and
tachycardia in 17. Scintigraphy demonstrated 154 lesions, 35.7% of which were located in the left lower lobe and 25.3% in the right lower lobe. Treatment mainly consisted of the administration of
heparin and
urokinase. Four of the 26 patients died. Intermittent pneumatic compression (IPC) with the administration of
heparin has been used in our department since 1994 to prevent PTE and this has also helped to decrease the incidence from 3.2% to 0.7%. Because the incidence of PTE following
esophagectomy is higher than expected, PTE should be considered whenever
hypoxemia of some unknown cause is found. Both early diagnosis and treatment are essential. It is also important to prevent PTE by the use of IPC.