What is the most common complication of esophagectomy?

From the Guidelines

The most common complication of oesophagectomy is respiratory complications (option 1). Following this major surgical procedure, patients frequently develop pneumonia, atelectasis, pleural effusions, and acute respiratory distress syndrome, as noted in the guidelines for the management of oesophageal and gastric cancer 1. These respiratory issues occur due to several factors, including the proximity of the surgical field to the lungs, manipulation of the thoracic cavity during surgery, one-lung ventilation techniques used intraoperatively, postoperative pain limiting effective coughing and deep breathing, and the generally compromised health status of many esophageal cancer patients.

Some of the key factors contributing to respiratory complications include:

• Pain from extensive incisions leading to decreased ventilation and atelectasis 1
• Impaired diaphragm movement due to incisions 1
• Poor lymphatic drainage of the pulmonary alveoli resulting in acute pulmonary oedema 1
• The use of thoracic epidural anaesthesia has been shown to significantly decrease the incidence of respiratory complications 1

While other complications such as anastomotic leaks, recurrent laryngeal nerve injury, and thoracic duct injury are significant, they occur less frequently than respiratory complications. Recurrent laryngeal nerve injury, for example, can impair the patient’s ability to cough in the early postoperative period and adequately protect the airway during swallowing, contributing to pulmonary morbidity 1. However, the majority of these injuries are unilateral and transient, and adequate compensation from the opposite cord is often present 1.

Preventive strategies to reduce the risk of respiratory complications following oesophagectomy include:

• Early mobilization
• Aggressive pulmonary toilet
• Incentive spirometry
• Pain management These strategies are essential in minimizing the risk of respiratory complications and improving patient outcomes following oesophagectomy.

From the Research

Commonest Complication of Oesophagectomy

The commonest complication of oesophagectomy is a significant concern in the medical field. Based on the provided studies, the following points can be made:

• Respiratory complications are a major cause of morbidity and mortality after oesophageal resection 2, 3.
• These complications affect about 30% of patients after oesophagectomy and 80% of these complications occur within the first five days 2.
• Respiratory complications include sputum retention, pneumonia, and ARDS 2.
• Impaired lung function is a significant risk factor for pulmonary complications after esophagectomy, especially for patients with forced expiratory volume in 1 second (FEV1) less than 65% of predicted 3.
• Preoperative chemoradiotherapy is also a risk factor for pulmonary complications after esophagectomy 3.
• Non-invasive positive pressure ventilation (NPPV) may be an effective treatment for postoperative acute respiratory failure (ARF) after oesophagectomy, reducing the reintubation rate and frequency of acute respiratory distress syndrome (ARDS) 4.
• The development of ARDS after oesophagectomy is associated with a longer intensive care stay, longer hospital stay, and more non-respiratory organ failure 5.
• Older patients and those with mid-oesophageal tumours have a higher risk for ARDS 5.

Comparison of Complications

Comparing the given options:

• Respiratory complication is the most common complication of oesophagectomy, as supported by the studies 2, 3, 6, 5.
• Anastomosis leak is also a complication, but its incidence is lower compared to respiratory complications 4.
• Recurrent laryngeal nerve injury and thoracic duct injury are not mentioned as the most common complications in the provided studies. Therefore, based on the evidence, the correct answer is:

1. Respiratory complication.