Functional syndromes and symptom-orientated aftercare after esophagectomy

Abstract

Background Surgery is the cornerstone of esophageal cancer treatment but remains burdened with significant postoperative changes of gastrointestinal function and quality of life. Purpose The aim of this narrative review is to assess and summarize the current knowledge on postoperative functional syndromes and quality of life after esophagectomy for cancer, and to provide orientation for the reader in the challenging field of functional aftercare. Conclusions Post-esophagectomy syndromes include various conditions such as dysphagia, reflux, delayed gastric emptying, dumping syndrome, weight loss, and chronic diarrhea. Clinical pictures and individual expressions are highly variable and may be extremely distressing for those affected. Therefore, in addition to a mostly well-coordinated oncological follow-up, we strongly emphasize the need for regular monitoring of physical well-being and gastrointestinal function. The prerequisite for an effective functional aftercare covering the whole spectrum of postoperative syndromes is a comprehensive knowledge of the pathophysiological background. As functional conditions often require a complex diagnostic workup and long-term therapy, close interdisciplinary cooperation with radiologists, gastroenterologists, oncologists, and specialized nutritional counseling is imperative for successful management.

Safety and efficacy of vagus nerve preservation technique during minimally invasive esophagectomy

“…Traditional open esophagectomy is accompanied by a high incidence of postoperative complications, and MIE has been shown to be a safe and feasible alternative that does not compromise the prognosis of patients (12,14). Some common but severe postoperative complications, such as dumping syndrome, diarrhea, and abdominal distension are considered to be associated with the truncal vagotomy (15,16). Thus, a vagalsparing esophagectomy using MIE would theoretically be a better and promising technique.…”

The Unhappy Gastric Conduit: A Medical Perspective

“…The loss of gastric accommodation, formation of tubular gastric conduit, and denervation injury that may occur after vagotomy impact the normal transit of contents through the pylorus, allowing for rapid emptying of hyperosmolar contents. 82 Resultantly, patients with vagal-sparing esophagectomies have significantly lower rates of dumping symptoms compared to those who received vagotomy. 83 Furthermore, patients with pylorus draining procedures are more likely to experience dumping symptoms.…”

Non-invasive thoracoabdominal mapping of post-oesophagectomy conduit function

“…Procedural variations exist, dependent on patient and disease factors, with the stomach typically being used for reconstruction. Post-oesophagectomy conduit dysfunction is common, including delayed gastric conduit emptying (DGCE) (~30%) , gastro-oesophageal reflux (~80%), and other chronic symptoms without a mechanical cause (1,2). Emerging evidence implicates abnormal gastric electrophysiology as a contributing factor (3)(4)(5).…”