From the Guidelines
The most common complication of oesophagectomy is respiratory complications (option B). Following this major surgical procedure, patients frequently develop pneumonia, atelectasis, acute respiratory distress syndrome (ARDS), or respiratory failure, as noted in the guidelines for the management of oesophageal and gastric cancer 1. These complications occur due to several factors, including:
- The proximity of the surgical field to the lungs
- Manipulation of the thoracic cavity
- One-lung ventilation during surgery
- Postoperative pain limiting effective coughing and deep breathing
- The generally compromised health status of many esophageal cancer patients While anastomotic leaks, recurrent laryngeal nerve injury, and thoracic duct injury are significant complications of oesophagectomy, they occur less frequently than respiratory complications, as discussed in the context of esophageal and esophagogastric junction cancers 1. Early mobilization, aggressive pulmonary toilet, incentive spirometry, and pain control are essential preventive measures to reduce the risk of these respiratory complications. The use of thoracic epidural anaesthesia has been shown to significantly decrease the incidence of respiratory complications 1. Minimally invasive esophagectomy (MIE) strategies may be associated with decreased morbidity and shorter recovery times, but open surgery should remain the standard for many patients, especially in certain settings such as previous abdominal surgery or large and bulky tumors 1.
From the Research
Most Common Complication of Oesophagectomy
The most common complication of oesophagectomy is a topic of interest in the medical field. Based on the provided evidence, the following points can be made:
- Respiratory complications are a major cause of morbidity and mortality after oesophageal resection 2, 3, 4, 5.
- Studies have shown that respiratory complications affect about 30% of patients after oesophagectomy 2 and 23.3% of patients in another study 3.
- The most common respiratory complications include sputum retention, pneumonia, and acute respiratory distress syndrome (ARDS) 2.
- Risk factors for respiratory complications after esophagectomy include advanced age, smoking, alcohol use, dyspnea, history of chronic obstructive pulmonary disease, and prolonged operative time 3, 4.
- Anastomotic leakage, pneumonia, ARDS, and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the main causes of death in patients with acute respiratory failure (ARF) after esophagectomy 5.
Comparison of Options
Comparing the options provided:
- A. Anastomotic leak: while anastomotic leakage is a complication of oesophagectomy, it is not the most common complication.
- B. Respiratory complications: based on the evidence, respiratory complications are the most common complication of oesophagectomy.
- C. Recurrent laryngeal nerve injury: there is no evidence provided to suggest that recurrent laryngeal nerve injury is the most common complication of oesophagectomy.
- D. Thoracic duct injury: there is no evidence provided to suggest that thoracic duct injury is the most common complication of oesophagectomy.
Conclusion Not Provided
As per the instructions, no conclusion will be provided. However, based on the evidence, it can be seen that: