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Early Results: Morbidity, Mortality, and the Treatment of Complications

  • Chapter
Treatment of Esophageal and Hypopharyngeal Squamous Cell Carcinoma

Part of the book series: Updates in Surgery ((UPDATESSURG))

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Abstract

Despite the significant technical improvements and advances in both surgical technique and peri-operative management, esophagectomy is still associated with high morbidity and mortality [1–4]. The complication rate seems to be related to a number of factors; indeed, the characteristics and behavior of the patients as well as technical problems are often associated with an increased risk of postoperative complications following esophagectomy. Furthermore, multivariate analysis has pointed to a significantly higher risk of recurrence for patients with complications after esophagectomy than in those in whom the procedure was uneventful [5]. An accurate definition of a complication and a method to assess its severity are still lacking. Recently, a more accurate classification of surgical complications was proposed based on a cohort of 6336 patients (Table 16.1) [6].

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References

  1. Dhungel B, Diggs BS, Hunter JG et al (2010) Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005–2008. J Gastrointest Surg 14:1492–1501

    Article  PubMed  Google Scholar 

  2. Bailey SH, Bull DA, Harpole DH et al (2003) Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 75:217–222

    Article  PubMed  Google Scholar 

  3. Wright CD, Kucharczuk JC, O’Brien SM et al (2009) Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg 137:587–595

    Article  PubMed  Google Scholar 

  4. Atkins BZ, Shah AS, Hutcheson KA et al (2004) Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 78:1170–1176

    Article  PubMed  Google Scholar 

  5. Lerut T, Moons J, Coosemans W et al (2009) Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg 250:798–807

    Article  PubMed  Google Scholar 

  6. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  7. Morita M, Nakanoko T, Fujinaka Y et al (2011) In-hospital mortality after a surgical resection for esophageal cancer: analyses of the associated factors and historical changes. Ann Surg Oncol 18:1757–1765

    Article  PubMed  Google Scholar 

  8. Zingg U, Smithers BM, Gotley DC et al (2011) Factors associated with postoperative pulmonary morbidity after esophagectomy for cancer. Ann Surg Oncol 18:1460–1468

    Article  PubMed  Google Scholar 

  9. Law S, Wong KH, Kwok KF et al (2004) Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 240:791–800

    Article  PubMed Central  PubMed  Google Scholar 

  10. Ferguson MK, Durkin AE (2002) Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg 123:661–669

    Article  PubMed  Google Scholar 

  11. Kita T, Mammoto T, Kishi Y (2002) Fluid management and postoperative respiratory disturbances in patients with transthoracic esophagectomy for carcinoma. J Clin Anesth 14:252–256

    Article  PubMed  Google Scholar 

  12. Whooley BP, Law S, Murthy SC et al (2001) Analysis of reduced death and complication rates after esophageal resection. Ann Surg 233:338–344

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Kinugasa S, Tachibana M, Yoshimura et al (2004) Postoperative pulmonary complications are associated with worse short-and long-term outcomes after extended esophagectomy. J Surg Oncol 88:71–77

    Article  PubMed  Google Scholar 

  14. Avendano CE, Flume PA, Silvestri GA, King LB, Reed CE (2002) Pulmonary complications after esophagectomy. Ann Thorac Surg 73:922–926

    Article  PubMed  Google Scholar 

  15. Akutsu Y, Matsubara H (2009) Perioperative management for the prevention of postoperative pneumonia with esophageal surgery. Ann Thorac Cardiovasc Surg 15:280–285

    PubMed  Google Scholar 

  16. Nakamura M, Iwahashi M, Nakamori M et al (2008) An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg 393:127–133

    Article  PubMed  Google Scholar 

  17. Michelet P, D’Journo XB, Roch A et al (2006) Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology 105:911–919

    Article  PubMed  Google Scholar 

  18. Morita M, Yoshida R, Ikeda K et al (2008) Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid. Dis Esophagus 21:30–36

    CAS  PubMed  Google Scholar 

  19. Tandon S, Batchelor A, Bullock R (2001) Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth 86:633–638

    Article  CAS  PubMed  Google Scholar 

  20. Saeki H, Ishimura H, Higashi H et al (2009) Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy. Surg Today 39:476–480

    Article  PubMed  Google Scholar 

  21. Casado D, Lopez F, Marti R (2010) Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus 23:523–528

    Article  CAS  PubMed  Google Scholar 

  22. Wei S, Tian J, Song X, Chen Y (2008) Association of perioperative fluid balance and adverse surgical outcomes in esophageal cancer and esophagogastric junction cancer. Ann Thorac Surg 86:266–272

    Article  Google Scholar 

  23. Hughes CG, Weavind L, Banerjee A et al (2010) Intraoperative risk factors for acute respiratory distress syndrome in critically ill patients. Anesth Analg 111:464–467

    Article  PubMed  Google Scholar 

  24. Neal JM, Wilcox RT, Allen HW, Low DE (2003) Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction. Reg Anesth Pain Med 28:328–334

    PubMed  Google Scholar 

  25. Hogan BA, Winter DC, Broe D et al (2008) Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery. Surg Endosc 22:767–771

    Article  PubMed  Google Scholar 

  26. Blewett CJ, Miller JD, Young JE et al (2001) Anastomotic leaks after esophagectomy for esophageal cancer: a comparison of thoracic and cervical anastomoses. Ann Thorac Cardiovasc Surg 7:75–78

    CAS  PubMed  Google Scholar 

  27. Korst RJ, Port JL, Lee PC, Altorki NK (2005) Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma. Ann Thorac Surg 80:1185–1190

    Article  PubMed  Google Scholar 

  28. van Heijl M, van Wijngaarden AK, Lagarde SM et al (2010) Intrathoracic manifestations of cervical anastomotic leaks after transhiatal and transthoracic oesophagectomy. Br J Surg 97:726–731

    Article  PubMed  Google Scholar 

  29. Escofet X, Manjunath A, Twine C et al (2010) Prevalence and outcome of esophagogastric anastomotic leak after esophagectomy in a UK regional cancer network. Dis Esophagus 23:112–116

    Article  CAS  PubMed  Google Scholar 

  30. Tabatabai A, Hashemi M, Mohajeri G et al (2009) Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med 4:197–200

    Article  PubMed Central  PubMed  Google Scholar 

  31. Martin LW, Swisher SG, Hofstetter W et al (2005) Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg 242:392–399

    PubMed Central  PubMed  Google Scholar 

  32. Alanezi K, Urschel JD (2004) Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 10:71–75

    PubMed  Google Scholar 

  33. Schuchert MJ, Abbas G, Nason KS et al (2010) Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery 148:831–838

    Article  PubMed  Google Scholar 

  34. Griffin SM, Lamb PJ, Dresner SM et al (2001) Diagnosis and management of a mediastinal leak following radical oesophagectomy. Br J Surg 88:1346–1351

    Article  CAS  PubMed  Google Scholar 

  35. Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:634–640

    Article  CAS  PubMed  Google Scholar 

  36. Tirnaksiz MB, Deschamps C, Allen MS, Johnson DC, Pairolero PC (2005) Effectiveness of screening aqueous contrast swallow in detecting clinically significant anastomotic leaks after esophagectomy. Eur Surg Res 37:123–128

    Article  CAS  PubMed  Google Scholar 

  37. Strauss C, Mal F, Perniceni T et al (2010) Computed tomography versus water-soluble contrast swallow in the detection of intrathoracic anastomotic leak complicating esophagogastrectomy (Ivor Lewis): a prospective study in 97 patients. Ann Surg 251:647–651

    Article  PubMed  Google Scholar 

  38. Turkyilmaz A, Eroglu A, Aydin Y et al (2009) The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma. Dis Esophagus 22:119–126

    Article  CAS  PubMed  Google Scholar 

  39. Chang AC, Ji H, Birkmeyer NJ et al (2008) Outcomes after transhiatal and transthoracic esophagectomy for cancer. Ann Thorac Surg 85:424–429

    Article  PubMed  Google Scholar 

  40. Connors RC, Reuben BC, Neumayer LA, Bull DA (2007) Comparing outcomes after transthoracic and transhiatal esophagectomy: a 5-year prospective cohort of 17,395 patients. J Am Coll Surg 205:735–740

    Article  PubMed  Google Scholar 

  41. Junginger T, Gockel I, Heckhoff S (2006) A comparison of transhiatal and transthoracic resections on the prognosis in patients with squamous cell carcinoma of the esophagus. Eur J Surg Oncol 32:749–755

    Article  CAS  PubMed  Google Scholar 

  42. Morgan MA, Lewis WG, Hopper AN et al (2007) Prospective comparison of transthoracic versus transhiatal esophagectomy following neoadjuvant therapy for esophageal cancer. Dis Esophagus 20:225–231

    Article  CAS  PubMed  Google Scholar 

  43. Rentz J, Bull D, Harpole D et al (2003) Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. J Thorac Cardiovasc Surg 125:1114–1120

    Article  PubMed  Google Scholar 

  44. Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669

    Article  PubMed  Google Scholar 

  45. Ott K, Bader FG, Lordick F et al (2009) Surgical factors influence the outcome after Ivor-Lewis esophagectomy with intrathoracic anastomosis for adenocarcinoma of the esophagogastric junction: a consecutive series of 240 patients at an experienced center. Ann Surg Oncol 16:1017–1025

    Article  PubMed  Google Scholar 

  46. Griffin SM, Shaw IH, Dresner SM (2002) Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management. J Am Coll Surg 194:285–297

    Article  PubMed  Google Scholar 

  47. Mariette C, Taillier G, Van Seuningen I, Triboulet JP (2004) Factors affecting postoperative course and survival after en bloc resection for esophageal carcinoma. Ann Thorac Surg 78:1177–1183

    Article  PubMed  Google Scholar 

  48. Karl RC, Schreiber R, Boulware D et al (2000) Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 231:635–643

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175:47–51

    Article  CAS  PubMed  Google Scholar 

  50. Fujita H, Sueyoshi S, Tanaka T et al (2003) Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: comparing the short-and long-term outcome among the four types of lymphadenectomy. World J Surg 27:571–579

    Article  PubMed  Google Scholar 

  51. Shim YM, Kim HK, Kim K (2010) Comparison of survival and recurrence pattern between two-field and three-field lymph node dissections for upper thoracic esophageal squamous cell carcinoma. J Thorac Oncol 5:707–712

    Article  PubMed  Google Scholar 

  52. Igaki H, Tachimori Y, Kato H (2004) Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg 239:483–490

    Article  PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  54. Munitiz V, Martinez-de-Haro LF, Ortiz A et al (2010) Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy. Br J Surg 97:714–718

    Article  CAS  PubMed  Google Scholar 

  55. Cerfolio RJ, Bryant AS, Bass CS et al (2004) Fast tracking after Ivor Lewis esophagogastrectomy. Chest 126:1187–1194

    Article  PubMed  Google Scholar 

  56. Jiang K, Cheng L, Wang JJ et al (2009) Fast track clinical pathway implications in esophagogastrectomy. World J Gastroenterol 15: 496–501

    Article  PubMed Central  PubMed  Google Scholar 

  57. Low DE, Kunz S, Schembre D et al (2007) Esophagectomy—it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 11:1395–1402

    Article  PubMed  Google Scholar 

  58. Robertson SA, Skipworth RJ, Clarke DL et al (2006) Ventilatory and intensive care requirements following oesophageal resection. Ann R Coll Surg Engl 88:354–357

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  59. Chandrashekar MV, Irving M, Wayman J et al (2003) Immediate extubation and epidural analgesia allow safe management in a high-dependency unit after two-stage oesophagectomy. Results of eight years of experience in a specialized upper gastrointestinal unit in a district general hospital. Br J Anaesth 90:474–479

    Article  CAS  PubMed  Google Scholar 

  60. Lanuti M, de Delva PE, Maher A et al (2006) Feasibility and outcomes of an early extubation policy after esophagectomy. Ann Thorac Surg 82:2037–2041

    Article  PubMed  Google Scholar 

  61. Yap FH, Lau JY, Joynt GM et al (2003) Early extubation after transthoracic oesophagectomy. Hong Kong Med J 9:98–102

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dept. of Surgery, Upper G.I. Surgery Division, University of Verona, Verona, Italy

    Giovanni de Manzoni

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  1. Giovanni de Manzoni
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  2. Andrea Zanoni
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  3. Jacopo Weindelmayer
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  1. Dept. of Surgery Upper G.I. Surgery Division, University of Verona, Verona, Italy

    Giovanni de Manzoni

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de Manzoni, G., Zanoni, A., Weindelmayer, J. (2012). Early Results: Morbidity, Mortality, and the Treatment of Complications. In: de Manzoni, G. (eds) Treatment of Esophageal and Hypopharyngeal Squamous Cell Carcinoma. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-2330-7_16

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  • DOI: https://doi.org/10.1007/978-88-470-2330-7_16

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2329-1

  • Online ISBN: 978-88-470-2330-7

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