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

0 Comments

Editorial

01 February 2023 : Editorial  

Editorial: The XBB.1.5 (‘Kraken’) Subvariant of Omicron SARS-CoV-2 and its Rapid Global Spread

Dinah V. Parums
Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA

DOI: 10.12659/MSM.939580

Med Sci Monit 2023; 29:e939580

SARS-CoV-2/COVID-19

19 January 2023 : Clinical Research  

Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During ...

Med Sci Monit In Press; DOI: 10.12659/MSM.938892  

27 December 2022 : Clinical Research  

Effect of Physiotherapy to Correct Rounded Shoulder Posture in 30 Patients During the COVID-19 Pandemic in ...

Med Sci Monit 2022; 28:e938926

10 December 2022 : Clinical Research  

Retrospective Study to Identify Risk Factors for Severe Disease and Mortality Using the Modified Early Warn...

Med Sci Monit 2022; 28:e938647

In Press

02 Feb 2023 : Clinical Research  

Online Questionnaire-Based Study to Evaluate the Attitudes and Use of Rubber Dental Dams by Saudi Dental Pr...

Med Sci Monit In Press; DOI: 10.12659/MSM.938672  

02 Feb 2023 : Database Analysis  

Prognostic-Related Biomarkers in Pancreatic Ductal Adenocarcinoma Correlating with Immune Infiltrates Based...

Med Sci Monit In Press; DOI: 10.12659/MSM.938785  

01 Feb 2023 : Clinical Research  

Comparison of 3 Enzyme-Linked Immunoassay Methods to Evaluate Serum Concentrations of Infliximab and Antibo...

Med Sci Monit In Press; DOI: 10.12659/MSM.939084  

31 Jan 2023 : Clinical Research  

Balloon Dilation Eustachian Tuboplasty Combined with Tympanotomy Tube Insertion for Treatment of Refractory...

Med Sci Monit In Press; DOI: 10.12659/MSM.938879  

Most Viewed Current Articles

13 Nov 2021 : Clinical Research  

Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...

DOI :10.12659/MSM.932788

Med Sci Monit 2021; 27:e932788

30 Dec 2021 : Clinical Research  

Retrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...

DOI :10.12659/MSM.935379

Med Sci Monit 2021; 27:e935379

08 Mar 2022 : Review article  

A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...

DOI :10.12659/MSM.936292

Med Sci Monit 2022; 28:e936292

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

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