Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/Perioperative Quality Initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy

Abstract

Background Pulmonary complications are the most common morbidity after oesophagectomy, contributing to mortality and prolonged postoperative recovery, and have a negative impact on health-related quality of life. A variety of single or bundled interventions in the perioperative setting have been developed to reduce the incidence of pulmonary complications. Significant variation in practice exists across the UK. The aim of this modified Delphi consensus was to deliver clear evidence-based consensus recommendations regarding intraoperative and postoperative care that may reduce pulmonary complications after oesophagectomy. Methods With input from a multidisciplinary group of 23 experts in the perioperative management of patients undergoing surgery for oesophageal cancer, a modified Delphi method was employed. Following an initial systematic review of relevant literature, a range of anaesthetic, surgical, and postoperative care interventions were identified. These were then discussed during a two-part virtual conference. Recommendation statements were drafted, refined, and agreed by all attendees. The level of evidence supporting each statement was considered. Results Consensus was reached on 12 statements on topics including operative approach, pyloric drainage strategies, intraoperative fluid and ventilation strategies, perioperative analgesia, postoperative feeding plans, and physiotherapy interventions. Seven additional questions concerning the perioperative management of patients undergoing oesophagectomy were highlighted to guide future research. Conclusion Clear consensus recommendations regarding intraoperative and postoperative interventions that may reduce pulmonary complications after oesophagectomy are presented.

The effects of regional anesthesia combined with awake delayed extubation in patients undergoing esophageal cancer surgery: a single-blind randomized controlled trial

“…Previous studies showed that perioperative interventions, including protective ventilation strategy [18,19], high-ow nasal cannula [20], epidural analgesia and regional anesthesias [21], respiratory physiotherapy [22,23], can reduce PPCs and improve oxygenation with thoracic and abdominal surgery. However, no high-quality evidence was found for interventions to reduce incidence of PPCs [24,25]. An intraoperative mechanical ventilation strategy with a higher level of PEEP and recruitment maneuvers did not reduce PPCs and protect postoperative spirometry in noncardiac surgery [26][27][28].…”