Editorial
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World J Gastroenterol. Oct 21, 2013; 19(39): 6509-6514
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6509
Strategies to reduce pulmonary complications after esophagectomy
Teus J Weijs, Jelle P Ruurda, Grard AP Nieuwenhuijzen, Richard van Hillegersberg, Misha DP Luyer
Teus J Weijs, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Grard AP Nieuwenhuijzen, Misha DP Luyer, Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
Author contributions: Weijs TJ searched literature and wrote the manuscript; Luyer MDP was closely involved and supervised drafting of the manuscript and the writing process; Ruurda JP, Nieuwenhuijzen GAP and van Hillegersberg R were equally involved in drafting the manuscript and proofreading; All authors approved the final manuscript.
Correspondence to: Misha DP Luyer, MD, PhD, Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. misha.luyer@catharinaziekenhuis.nl
Telephone: +31-40-2397155 Fax: +31-40-2443370
Received: June 29, 2013
Revised: August 23, 2013
Accepted: September 4, 2013
Published online: October 21, 2013
Processing time: 131 Days and 19.8 Hours
Abstract

Esophagectomy, the surgical removal of all or part of the esophagus, is a surgical procedure that is associated with high morbidity and mortality. Pulmonary complications are an especially important postoperative problem. Therefore, many perioperative strategies to prevent pulmonary complications after esophagectomy have been investigated and introduced in daily clinical practice. Here, we review these strategies, including improvement of patient performance and technical advances such as minimally invasive surgery that have been implemented in recent years. Furthermore, interventions such as methylprednisolone, neutrophil elastase inhibitor and epidural analgesia, which have been shown to reduce pulmonary complications, are discussed. Benefits of the commonly applied routine nasogastric decompression, delay of oral intake and prophylactic mechanical ventilation are unclear, and many of these strategies are also evaluated here. Finally, we will discuss recent insights and new developments aimed to improve pulmonary outcomes after esophagectomy.

Keywords: Esophagectomy; Complications; Pneumonia; Acute lung injury; Acute respiratory distress syndrome

Core tip: Pulmonary complications following esophagectomy significantly contribute to postoperative morbidity and mortality. Over the years many strategies aimed at reducing pulmonary complications have been investigated. In the current article, we discuss these strategies, specifically minimally invasive surgical techniques; anti-inflammatory therapies and optimization of patient performance.