Esophagectomy for esophageal carcinoma - surgical complications and treatment

Abstract

Aim. To describe our experience with esophagectomy for esophageal cancer and, the development and treatment of complications arising from the surgery. Material and methods. From 2007 to 8/2010, esophagectomy for esophageal carcinoma was performed in 75 patients at the 1 st Surgical Clinic. Primary esophagectomy was indicated in 20 patients with T1N0 stage or in cases where neoadjuvant treatment was contraindicated. 55 patients with T2,3N0,1 stages received neoadjuvant radiochemotherapy. Esophagectomy was performed via an abdominal approach (transhiatal laparoscopy in 44 patients, laparotomy in 3 patients) and a thoracic approach (thoracoscopy in 10 patients, thoracotomy in 18 patients).Results. In 18 cases, one or both pleural cavities were opened by means of dissection of the mediastinal pleura during the transhiatal laparoscopic esophagectomy. The morbidity was 26.6% and the following complications were encountered: pulmonary (15 patients), anastomosis dehiscence (5), postoperative bleeding in the mediastinum (1), fistula between trachea and transposition (1), paresis of the left recurrent nerve (8), infectious complications in the abdominal cavity (2), thoracic cavity (1), and early complications (2). The sixty-day mortality was 8% and this was mostly due to pulmonary complications (4 patients) but included coronary thrombosis (1) and transposition necrosis (1). Conclusion. The dominating complications of esophagectomy were pulmonary (20 %). The remaining serious complications cannot be completely eliminated but if diagnosed in time and treated in a correct algorithm they do not have to imminently threaten the lives of patients.

Transcatheter arterial embolization with N-butyl cyanoacrylate for arterial esophageal bleeding in esophageal cancer patients

“…Treatment of esophageal bleeding with TAE with NBCA in patients with postoperative esophageal cancer has not been reported. The typical complications of surgery such as hemorrhage cannot be completely eliminated, and severe hemorrhage is a rare and potentially lethal complication after esophagectomy [ 1 , 26 ].…”

“…Esophageal cancer patients may suffer lethal esophageal artery bleeding [ 1 ]. Conventionally, the traditional first line of therapy for intraesophageal bleeding from the esophageal artery is an endoscopic procedure [ 2 ] and that for intrapleural bleeding is surgery [ 3 ].…”

Management of Complications of Radical Esophagectomy

“…The incidence of pulmonary complications ranges from 17 % to 50 % in literature [8][9][10]. Published literature confirms that pulmonary complications are most often associated with post-operative mortality.…”