Elsevier

Thoracic Surgery Clinics

Volume 16, Issue 1, February 2006, Pages 35-48
Thoracic Surgery Clinics

Respiratory Complications After Esophagectomy

https://doi.org/10.1016/j.thorsurg.2006.01.007Get rights and content

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Significance of pulmonary complications after esophageal resection

Review of the available literature clarifies the significance of pulmonary complications after ER. For instance, numerous studies have demonstrated that the development of pulmonary complications is associated with increased perioperative mortality after esophagectomy [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]. Table 1 presents a review of the recent literature, including the rate and significance of pulmonary complications. In the Duke series, pneumonia was

Induction chemoradiation and pulmonary complications

Because induction therapy is increasingly used for esophageal cancer, it has been suggested that this treatment may contribute to pulmonary complications, among others, after ER. Bosset and colleagues [49] compared 139 patients who underwent ER alone with 143 patients who had induction therapy followed by ER. Although no difference in overall survival was seen, patients receiving induction therapy had significantly increased perioperative mortality (P=.012), possibly caused by the presence of

Operative factors affecting pulmonary complications

Several operative factors have been associated with increased rates of pulmonary complications as well as increased mortality after ER. These factors include increased intraoperative blood loss or the need for intraoperative/perioperative blood transfusions, the length of the surgical procedure, tumor characteristics, and operative techniques used for resection.

Laryngopharyngeal dysfunction

It is apparent that laryngopharyngeal dysfunction, a term that encompasses a spectrum of disorders including swallowing abnormalities, dysphagia, and poor airway protection, is the most important and the most prevalent cause of respiratory complications after ER [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72]. The presence of laryngopharyngeal dysfunction in the postoperative period is most commonly attributed to RLN injury during surgery with resultant

Strategies to reduce pulmonary complications after esophageal resection

In light of the multiple contributors to pulmonary complications that have been identified after ER, several suggestions have been made to reduce the rates and severity of these disorders. Unfortunately, few of these suggestions have been well studied or validated. Nonetheless, based on the current literature, several centers have incorporated many of these suggestions into the postoperative care of ER patients and have had success in reducing rates of pulmonary complications and the untoward

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