An important role of silent aspiration of gastric contents as a cause of pulmonary complications following surgery for esophageal cancer.

The progress of postoperative chest X-ray films was analyzed in patients who had undergone radical surgery for esophageal cancer at the second Department of Surgery, Osaka University Medical School from 1969 to 1981. We subsequently reached a conclusion that abnormal shadows were caused by the intratracheal aspiration of oropharyngeal secretions or gastric contents. In particular, the aspiration of gastric contents was considered to be a factor in the occurrence and aggravation of pneumonia. In order to prevent aspiration of gastric contents, a drainage tube was inserted into the stomach as a reconstructive organ and endotracheal intubation was maintained for more than 24 hours post-operatively in order to suction the tracheobronchial secretion. Consequently, the frequency of occurrence and the aggravation of pneumonia decreased and the operative mortality rate improved significantly.