Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6509
Revised: August 23, 2013
Accepted: September 4, 2013
Published online: October 21, 2013
Processing time: 131 Days and 19.8 Hours
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.
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.