Logo Medical Science Monitor

Call: +1.631.470.9640
Mon - Fri 10:00 am - 02:00 pm EST

Contact Us

Logo Medical Science Monitor Logo Medical Science Monitor Logo Medical Science Monitor

28 July 2003

Complications of salvage esophagectomy

John D. Urschel, Frank W. Sellke

Med Sci Monit 2003; 9(7): RA173-180 :: ID: 13087

Abstract

Definitive chemoradiation (without surgery) is an accepted treatment for esophageal cancer. Persistent or recurrent local disease is not infrequent after chemoradiation, and this is its greatest drawback. Selected patients with isolated local failures of definitive chemoradiation can be salvaged by esophagectomy. However, salvage esophagectomy is a high-risk operation; operative mortality is higher than for standard esophagectomy. In contrast to planned esophagectomy after induction (neoadjuvant) therapy, salvage esophagectomy is often carried out months after completion of definitive chemoradiation. Previous thoracic radiotherapy contributes to the genesis of postoperative complications. Respiratory failure (ARDS, pneumonia) and septic complications of esophageal reconstruction (anastomotic leaks) are major causes of postoperative death. Gastric conduit necrosis, airway necrosis, and tracheogastric fistulae are infrequent but highly lethal complications. We propose modifications of surgical practice that may reduce complications. These include strict guidelines for patient selection, conservative mediastinal dissection, prevention of intraoperative lung injury (barotrauma and oxygen related toxicity), near total esophagectomy with cervical esophagogastric anastomosis, anterior mediastinal reconstruction, judicious use of staged reconstruction, perioperative enteral nutritional support, and aggressive detection and treatment of postoperative complications. By conceptually breaking the operation into component parts, such as resection and reconstruction, and then modifying each component to minimize complications, we believe that the operative mortality of salvage esophagectomy can be reduced to an acceptable level.

Keywords: Carcinoma, Squamous Cell - radiotherapy, Carcinoma, Squamous Cell - surgery, Combined Modality Therapy, Esophageal Neoplasms - radiotherapy, Esophageal Neoplasms - surgery, Esophagectomy - adverse effects, Esophagectomy - methods, Esophagectomy - mortality, Postoperative Care, Postoperative Complications, Reconstructive Surgical Procedures, Salvage Therapy - adverse effects, Salvage Therapy - methods, Salvage Therapy - mortality

Add Comment 0 Comments

Editorial

01 February 2024 : Editorial  

Editorial: Global Health Concerns as Vaccine-Preventable Infections Including SARS-CoV-2 (JN.1), Influenza, Respiratory Syncytial Virus (RSV), and Measles Continue to Rise

Dinah V. Parums

DOI: 10.12659/MSM.943911

Med Sci Monit 2024; 30:e943911

0:00

In Press

01 Feb 2024 : Review article  

Review of the Evaluation of Pulmonary Hypoplasia as an Important Determinant of Clinical Outcomes in Infant...

Med Sci Monit In Press; DOI: 10.12659/MSM.943259  

0:00

19 Feb 2024 : Clinical Research  

Diagnostic Accuracy of Ileocolic Artery and Vein Diameter for Acute Appendicitis

Med Sci Monit In Press; DOI: 10.12659/MSM.943846  

23 Feb 2024 : Clinical Research  

Early Mobilization in Pediatric Critical Care: Exploring the Gap Between Theory and Practice in Saudi Arabia

Med Sci Monit In Press; DOI: 10.12659/MSM.942467  

01 Feb 2024 : Review article  

Enhancing Patient Adherence to Newly-Prescribed Medicine for Chronic Diseases: A Comprehensive Review and C...

Med Sci Monit In Press; DOI: 10.12659/MSM.942923  

Most Viewed Current Articles

16 May 2023 : Clinical Research  

Electrophysiological Testing for an Auditory Processing Disorder and Reading Performance in 54 School Stude...

DOI :10.12659/MSM.940387

Med Sci Monit 2023; 29:e940387

0:00

17 Jan 2024 : Review article  

Vaccination Guidelines for Pregnant Women: Addressing COVID-19 and the Omicron Variant

DOI :10.12659/MSM.942799

Med Sci Monit 2024; 30:e942799

0:00

14 Dec 2022 : Clinical Research  

Prevalence and Variability of Allergen-Specific Immunoglobulin E in Patients with Elevated Tryptase Levels

DOI :10.12659/MSM.937990

Med Sci Monit 2022; 28:e937990

0:00

01 Jan 2022 : Editorial  

Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...

DOI :10.12659/MSM.935952

Med Sci Monit 2022; 28:e935952

0:00

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750