What is the most common complication of esophagectomy?

From the Guidelines

Respiratory complications are the most common complication of oesophagectomy, occurring in a significant proportion of patients. The proximity of the surgical field to the lungs, manipulation of the lungs during surgery, potential for aspiration, postoperative pain limiting deep breathing, and the generally compromised health status of many esophageal cancer patients contribute to the high incidence of respiratory complications 1. These complications can include pneumonia, atelectasis, respiratory failure requiring prolonged ventilation, and acute respiratory distress syndrome. Some key factors that contribute to respiratory complications include:

• Pain from extensive incisions, which can lead to decreased ventilation and atelectasis
• Impaired diaphragm movement due to incisions
• Poor lymphatic drainage of the pulmonary alveoli, resulting in a form of acute pulmonary oedema
• The use of thoracic epidural anaesthesia has been shown to significantly decrease the incidence of respiratory complications 1. In comparison to other complications, respiratory complications occur more frequently than:
• Anastomosis leak
• Recurrent laryngeal nerve injury
• Thoracic duct injury (chylothorax) Prevention strategies for respiratory complications are crucial and include:
• Preoperative pulmonary rehabilitation
• Smoking cessation
• Early mobilization
• Aggressive pulmonary toilet
• Pain management to facilitate deep breathing and coughing in the postoperative period.

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, 4.
• 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 acute respiratory distress syndrome (ARDS) 2, 3, 4.
• Factors associated with respiratory complications include smoking history, serum C-reactive protein (CRP), and forced expiratory volume (FEV1.0%) 3.
• Respiratory complications do not affect disease-free survival in patients with complete resection 5.
• Peri-operative cardiorespiratory instability is associated with acute lung injury after elective oesophagectomy 4.
• Non-invasive ventilation may be an effective treatment for postoperative respiratory failure after oesophagectomy, reducing the need for reintubation and intensive care stay 6.

Comparison of Options

Comparing the given options:

• Respiratory complication is the most frequently occurring complication after oesophagectomy, as supported by the studies 2, 3, 4.
• Anastomosis leak, recurrent laryngeal nerve injury, and thoracic duct injury are potential complications, but the provided studies do not indicate that they are the most common 6.
• Therefore, based on the evidence, the correct answer is:
  • 1. Respiratory complication