PERIOPERATIVE AND COMPLICATION MANAGEMENT FOR ADENOCARCINOMA OF THE ESOPHAGUS AND ESOPHAGOGASTRIC JUNCTION

Abstract

Esophagectomy remains a challenging procedure both for the patient and the surgeon. Patient selection and evaluation aims at preventing individuals unfit for surgery or without chance of cure from this operation. The use of modern operative techniques and in some cases sequential strategies help reduce the operative trauma. Regional anesthaesia and an individualized concept of perioperative pain treatment, early extubation, fluid restriction, mobilisation and physiotherapeutic assistance aims at the prevention of pulmonary complications, one of the dominant threats to this patient population. Rapid recognition and aggressive diagnostic work-up of any complication, especially anastomotic leaks, in the post-operative period is essential to prevent an uncontrolled progression of pathophysiologic cascades. A close multidisciplinary cooperation of surgeons, anaesthetists, endoscopists, radiologists and other associated disciplines is essential to further reduce the perioperative morbidity and mortality in this demanding surgical procedure