From the Guidelines
The commonest complication of oesophagectomy is respiratory complications (option 1). Following this major surgical procedure, patients frequently develop pulmonary issues including 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 complications occur due to several factors, including pain from extensive incisions, impaired diaphragm movement, and poor lymphatic drainage of the pulmonary alveoli, resulting in a form of acute pulmonary oedema 1. The use of thoracic epidural anaesthesia has been shown to significantly decrease the incidence of respiratory complications 1. While anastomotic leaks, recurrent laryngeal nerve injury, and thoracic duct injury are all recognized complications of oesophagectomy, they occur less frequently than respiratory complications. Key preventive measures in the postoperative period to reduce the risk of these respiratory complications include:
- Early mobilization
- Aggressive pulmonary toilet
- Incentive spirometry
- Pain control, with the use of thoracic epidural anaesthesia being a significant factor in decreasing respiratory complications 1.
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 concern after oesophagectomy, affecting about 30% of patients 2.
- These complications can include sputum retention, pneumonia, and acute respiratory distress syndrome (ARDS) 2, 3, 4.
- The incidence of respiratory complications is particularly high in the first five days after surgery 2.
- Factors associated with respiratory complications include preoperative, intraoperative, and postoperative factors, such as a low pre-operative body mass index, history of cigarette smoking, and the experience of the surgeon 3.
- Respiratory complications can have a significant impact on morbidity and mortality after oesophageal resection 2, 4.
- However, some studies suggest that respiratory complications may not affect disease-free survival in patients with complete resection 5.
Comparison of Options
Comparing the given options:
- Respiratory complication: supported by studies as a common complication of oesophagectomy 2, 3, 4.
- Anastomosis leak: mentioned as a potential complication, but not as common as respiratory complications 6.
- Recurrent laryngeal nerve injury: not mentioned in the provided studies.
- Thoracic duct injury: not mentioned in the provided studies.