Skip to main content
SpringerLink
Log in
Book cover

Esophageal Cancer pp 151–163Cite as

Perioperative Care and Management of Post-Operative Complications

  • Chapter
  • First Online:

  • 1271 Accesses

Abstract

As perioperative care plans become more complex and patient-centered, patient education and involvement are more essential. Predictors of adverse outcomes after esophagectomy include low spirometry, extremes of body mass index, advanced age, and neoadjuvant therapy. Perioperative care plans as part of enhanced recovery after surgery (ERAS) pathways include interventions designed to minimize the adverse impact of surgery on the patient, reduce postoperative complications, shorten duration of hospital stay, and lower costs. Despite improved risk stratification and interventions focused on modifiable risk factors, adverse outcomes have an important negative impact on hospital length of stay, morbidity and mortality. The most common postoperative complications are pneumonia, atrial fibrillation, anastomotic leak and chyle leak. Early identification and timely intervention are essential to minimize the effects of these potentially devastating complications.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38(6):1531–41.

    Article  PubMed  Google Scholar 

  2. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg. 2014;101(3):172–88.

    Article  CAS  PubMed  Google Scholar 

  3. Lemanu DP, Singh PP, Stowers MD, Hill AG. A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Color Dis. 2014;16(5):338–46.

    Article  CAS  Google Scholar 

  4. Joliat GR, Labgaa I, Petermann D, Hübner M, Griesser AC, Demartines N, Schäfer M. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br J Surg. 2015;102(13):1676–83.

    Article  PubMed  Google Scholar 

  5. Shewale JB, Correa AM, Baker CM, Villafane-Ferriol N, Hofstetter WL, Jordan VS, Kehlet H, Lewis KM, Mehran RJ, Summers BL, Schaub D, Wilks SA, Swisher SG. Impact of a fast-track esophagectomy protocol on esophageal cancer patient outcomes and hospital charges. Ann Surg. 2015;261(6):1114–23.

    Article  PubMed  Google Scholar 

  6. Underwood TJ, Noble F, Madhusudan N, Sharland D, Fraser R, et al. The development, application and analysis of an enhanced recovery programme for major oesophagogastric resection. J Gastrointest Surg. 2017;21(4):614–21.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Mastracci TM, Carli F, Finley RJ, Muccio S, Warner DO, Members of the Evidence-Based Reviews in Surgery Group. Effect of preoperative smoking cessation interventions on postoperative complications. J Am Coll Surg. 2011;212(6):1094–6.

    Article  PubMed  Google Scholar 

  8. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144–54.

    Article  PubMed  Google Scholar 

  9. Wong J, Lam DP, Abrishami A, Chan MT, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth. 2012;59(3):268–79.

    Article  PubMed  Google Scholar 

  10. Pouwels S, Fiddelaers J, Teijink JA. Cardiopulmonary exercise testing, prehabilitation, and enhanced recovery after surgery (ERAS). Can J Anaesth. 2012;62:131–42.

    Google Scholar 

  11. Nagarajan K, Bennett A, Agostini P, et al. Managing complications I: leaks, strictures, emptying, reflux, chylothorax is preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients? J Thorac Dis. 2014;6(3):355–63.

    Google Scholar 

  12. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693–700.

    Article  CAS  PubMed  Google Scholar 

  13. Sachs R, Stuttmann B, Bein P, Tonner M, Hein M, et al. Predictors for postoperative nausea and vomiting after xenon-based anaesthesia. Br J Anaes. 2015;115(1):61–7.

    Article  CAS  Google Scholar 

  14. Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC. Benchmarking complications associated with esophagectomy. Ann Surg. 2017. https://doi.org/10.1097/SLA.0000000000002611.

  15. Inoue J, Ono R, Makiura D. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2013;26(1):68–74.

    Article  CAS  PubMed  Google Scholar 

  16. Schieman C, Wigle DA, Deschamps C. Patterns of operative mortality following esophagectomy. Dis Esophagus. 2012;25:645.

    Article  CAS  PubMed  Google Scholar 

  17. Swanson SJ, Batirel HF, Bueno R. Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg. 2001;72:1918.

    Article  CAS  PubMed  Google Scholar 

  18. Abou-Jawde R, Mekhail T, Adelstein DJ, Rybicki LA, Mazzone PJ, et al. Impact of induction concurrent chemoradiotherapy on pulmonary function and postoperative acute respiratory complications in esophageal cancer. Chest. 2005;128(1):250–5.

    Article  PubMed  Google Scholar 

  19. Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg. 2011;91(5):1494–500.

    Article  PubMed  Google Scholar 

  20. Browner WS, Li J, Mangano DT. In-hospital and long-term mortality in male veterans following noncardiac surgery. The study of perioperative ischemia research group. JAMA. 1992;268(2):228–32.

    Article  CAS  PubMed  Google Scholar 

  21. Wightman SC, Posner MC, Patti MG, Ganai S, Watson S, Prachand V, Ferguson MK. Extremes of body mass index and postoperative complications after esophagectomy. Dis Esophagus. 2017;30(5):1–6.

    Article  CAS  PubMed  Google Scholar 

  22. Reinersman JM, Allen MS, Deschamps C, Ferguson MK, Nichols FC, et al. External validation of the Ferguson pulmonary risk score for predicting major pulmonary complications after oesophagectomy. Eur J Cardiothorac Surg. 2016;49(1):333–8.

    Article  PubMed  Google Scholar 

  23. Hasegawa T, Kubo N, Ohira M, Sakurai K, Toyokawa T, et al. Impact of body mass index on surgical outcomes after esophagectomy for patients with esophageal squamous cell carcinoma. J Gastrointest Surg. 2015;19(2):226–33.

    Article  PubMed  Google Scholar 

  24. Mitzman B, Schipper PH, Edwards MA, Kim S, Ferguson MK. Complications after esophagectomy are associated with extremes of body mass index: a Society of Thoracic Surgeons database study. Ann Thorac Surg. in press.

    Google Scholar 

  25. Kulkarni SR, Fletcher E, McConnell AK, Poskitt KR, Whyman MR. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot study. Ann R Coll Surg Engl. 2010;92:700–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Dettling DS, Van der Schaaf M, Blom RL, Nollet F, Busch OR, et al. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. Physiother Res Int. 2013;18:16–26.

    Article  PubMed  Google Scholar 

  27. Soutome S, Yanamoto S, Funahara M, Hasegawa T, Komori T, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: a multicenter case-control study with propensity score matching analysis. Medicine (Baltimore). 2017;96(33):e7436.

    Article  Google Scholar 

  28. Low DE, Alderson DE, Cecconello I, Chang AC, Darling GE, et al. International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy complications consensus group (ECCG). Ann Surg. 2015;262(2):286–94.

    Article  PubMed  Google Scholar 

  29. Murthy SC, Law S, Whooley BP, Alexandrou A, Chu KM, et al. Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality. J Thorac Cardiovasc Surg. 2003;126(4):1162–7.

    Article  PubMed  Google Scholar 

  30. Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, et al. AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg. 2014;148(3):e153–93.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Fleisher LA, Fleischmann K, Auerbach A, Barnason SA, Beckman JA. ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. A report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;130(24):2215–45.

    Article  PubMed  Google Scholar 

  32. Martin JT, Mahan AL, Ferraris VA, Saha SP, Mullett TW, et al. Identifying esophagectomy patients at risk for predischarge versus postdischarge venous thromboembolism. Ann Thorac Surg. 2015;100(3):932–8.

    Article  PubMed  Google Scholar 

  33. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2013;37:259–84.

    Article  CAS  PubMed  Google Scholar 

  34. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466–77.

    Article  CAS  PubMed  Google Scholar 

  35. Lobo F, Bostock KA, Neal KR, Perkins AC, Rowlands BJ. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359:1812–8.

    Article  PubMed  Google Scholar 

  36. Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to enhanced recovery after surgery (ERAS). Can J Anaesth. 2015;62(2):158–68.

    Article  PubMed  Google Scholar 

  37. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 2015;334(19):1209–15.

    Article  Google Scholar 

  38. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. JAMA. 1997;277(14):1127–34.

    Article  CAS  PubMed  Google Scholar 

  39. Zisman N, Wolf T. Strict thermoregulation attenuates myocardial injury during coronary artery bypass graft surgery as reflected by reduced levels of cardiac-specific troponin I. Anesth Analg. 2003;96(2):328–35.

    PubMed  Google Scholar 

  40. Schmied H, Kurz A, Sessler D, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347(8997):289–92.

    Article  CAS  PubMed  Google Scholar 

  41. Gottschalk A, Durieux ME, Nemergut EC. Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg. 2011;112(1):218–23.

    Article  CAS  PubMed  Google Scholar 

  42. Bilku DK, Dennison AR, Hall TC, Metcalfe MC, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96(1):15–22.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Yeung JHY, Gates S, Naidu BV, Wilson MJA, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2:CD009121.

    PubMed  Google Scholar 

  44. Wren SM, Martin M, Yoon JK, Bech F. Postoperative pneumonia-prevention program for the inpatient surgical ward. J Am Coll Surg. 2010;210(4):491–5.

    Article  PubMed  Google Scholar 

  45. Giacopuzzi S, Weindelmayer S, Treppiedi E, Bencivenga M, Ceola M. Enhanced recovery after surgery protocol in patients undergoing esophagectomy for cancer: a single center experience. Dis Esophagus. 2017;30(4):1–6.

    Article  CAS  PubMed  Google Scholar 

  46. D’Journo XB, Ouattara M, Loundou A, Trousse D, Dahan L. Prognostic impact of weight loss in 1-year survivors after transthoracic esophagectomy for cancer. Dis Esophagus. 2012;25(6):527–34.

    Article  PubMed  Google Scholar 

  47. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990;73:308–27.

    Article  CAS  PubMed  Google Scholar 

  48. Ljungqvist O. Modulating postoperative insulin resistance by preoperative carbohydrate loading. Best Pract Res Clin Anaesthesiol. 2009;23:401–9.

    Article  CAS  PubMed  Google Scholar 

  49. Svanfeldt M, Thorell A, Hausel J, Soop M, Rooyackers O. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. Br J Surg. 2007;94:1342–50.

    Article  CAS  PubMed  Google Scholar 

  50. McClave SA, Heyland DK. The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract. 2009;24:305–15.

    Article  PubMed  Google Scholar 

  51. Barlow AD, Thomas DC. Autophagy in diabetes: β-cell dysfunction, insulin resistance, and complications. DNA Cell Biol. 2015;34(4):252–60.

    Article  CAS  PubMed  Google Scholar 

  52. Nederlof N, Jonge J, Vringer T, Tran TC, Spaander MC. Does routine endoscopy or contrast swallow study after esophagectomy and gastric tube reconstruction change patient management? J Gastrointest Surg. 2017;21(2):251–8.

    Article  CAS  PubMed  Google Scholar 

  53. Biere SS, Maas KW, Cuesta MA, van der Peet DL. Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg. 2011;28:29–35.

    Article  CAS  PubMed  Google Scholar 

  54. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia. A randomized controlled trial. JAMA. 2005;293(5):589–95.

    Article  CAS  PubMed  Google Scholar 

  55. Milledge JS. Therapeutic fibreoptic bronchoscopy in intensive care. Br Med J. 2007;2(6049):1427–9.

    Article  Google Scholar 

  56. Radu DM, Jauréguy F, Seguin A, Foulon C, Destable MD. Postoperative pneumonia after major pulmonary resections: an unsolved problem in thoracic surgery. Ann Thorac Surg. 2007;84(5):1669–73.

    Article  PubMed  Google Scholar 

  57. Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A. Postesophagectomy chylothorax: incidence, risk factors and outcomes. Ann Thorac Surg. 2012;93(3):897–904.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Bolger C, Walsh TN, Tanner WA, Keeling P, Hennessy TP. Chylothorax after oesophagectomy. Br J Surg. 1991;78(5):587–8.

    Article  CAS  PubMed  Google Scholar 

  59. Maldonado F, Hawkins FJ, Daniels CE, Doerr CH, Decker PA. Pleural fluid characteristics of chylothorax. Mayo Clin Proc. 2009;84(2):129–33.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Kim D, Cho J, Kim K, Shim YM. Chyle leakage patterns and management after oncologic esophagectomy: a retrospective cohort study. Thorac Cancer. 2014;5(5):391–7.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Ismail NA, Gordon J, Dunning J. The use of octreotide in the treatment of chylothorax following cardiothoracic surgery. Interact Cardiovasc Thorac Surg. 2015;20(6):848–54.

    Article  PubMed  Google Scholar 

  62. Dugue L, Sauvanet A, Farges O, Goharin A, Le Mee J, Belghiti J. Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy. Br J Surg. 1998;85(8):1147–9.

    Article  CAS  PubMed  Google Scholar 

  63. Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA. Current management of postoperative chylothorax. Ann Thorac Surg. 2001;71(2):448–50.

    Article  CAS  PubMed  Google Scholar 

  64. Zabeck H, Muley T, Dienemann H, Hoffmann H. Management of chylothorax in adults: when is surgery indicated? Thorac Cardiovasc Surg. 2011;59(4):243–6.

    Article  CAS  PubMed  Google Scholar 

  65. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996;112(5):1361–5.

    Article  CAS  PubMed  Google Scholar 

  66. Nadolski GJ. Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients. Chest. 2013;143(1):158–63.

    Article  PubMed  Google Scholar 

  67. Guevara CJ, Rialon KL, Ramaswamy RS, Kim SK, Darcy MD. US-guided, direct puncture retrograde thoracic duct access, lymphangiography, and embolization: feasibility and efficacy. J Vasc Interv Radiol. 2016;27(12):1890–6.

    Article  PubMed  Google Scholar 

  68. Martin LW, Hofstetter W, Swisher SG, Roth JA. Management of intrathoracic leaks following esophagectomy. Adv Surg. 2006;40:173–90.

    Article  PubMed  Google Scholar 

  69. Ferguson MK. Reconstructive surgery of the esophagus. Hoboken, NJ: Wiley-Blackwell; 2008.

    Google Scholar 

  70. Freeman RK, Van Woerkom JM, Vyverberg A, Ascioti AJ. Esophageal stent placement for the treatment of spontaneous esophageal perforations. Ann Thorac Surg. 2009;88(1):194–8.

    Article  PubMed  Google Scholar 

  71. D’Cunha J, Rueth NM, Groth SS, Maddaus MA, Andrade RS. Esophageal stents for anastomotic leaks and perforations. J Thorac Cardiovasc Surg. 2011;142(1):39–46.

    Article  PubMed  Google Scholar 

  72. Langer FB, Wenzl E, Prager G. Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg. 2009;79:398–403.

    Article  Google Scholar 

  73. Sharma P, Kozarek R. Practice Parameters Committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2001;105:258–73.

    Article  Google Scholar 

  74. Schweigert M, Solymosi N, Dubecz A, González MP, Stein HJ. One decade of experience with endoscopic stenting for intrathoracic anastomotic leakage after esophagectomy: brilliant breakthrough or flash in the pan? Am Surg. 2014;80(8):736–45.

    PubMed  Google Scholar 

  75. Lanuti M, DeDelva P, Morse CR, Wright CD, Wain JC. Management of delayed gastric emptying after esophagectomy with endoscopic balloon dilatation of the pylorus. Ann Thorac Surg. 2011;91(4):1019–24.

    Article  PubMed  Google Scholar 

  76. Camilleri M, Parkman HP, Mehnaz S, Abell TL, Gerson L. Management of gastroparesis. Gastroenterology. 2013;108:18–37.

    CAS  Google Scholar 

  77. Smith DS, Williams CS, Ferris CD. Diagnosis and treatment of chronic gastroparesis and chronic intestinal pseudo-obstruction. Gastroenterol Clin N Am. 2003;32:619–58.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The University of Chicago, Chicago, IL, USA

    Andrew R. Brownlee & Mark K. Ferguson

Authors
  1. Andrew R. Brownlee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark K. Ferguson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark K. Ferguson .

Editor information

Editors and Affiliations

  1. Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina

    Francisco Schlottmann

  2. Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Daniela Molena

  3. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

    Marco G. Patti

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Brownlee, A.R., Ferguson, M.K. (2018). Perioperative Care and Management of Post-Operative Complications. In: Schlottmann, F., Molena, D., Patti, M. (eds) Esophageal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-91830-3_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-91830-3_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91829-7

  • Online ISBN: 978-3-319-91830-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation