Perioperative Risk Factors for Anastomotic Leakage After Esophagectomy

Quality-of-care indicators for oesophageal cancer surgery: A review

“…In an other series, TEA lowered the anastomotic leakage rate 105 . The authors suggested a causal relationship between hypoxemia and hypotension due to respiratory hypofunction in patients undergoing oesophagectomy without the use of TEA.…”

Case Scenario: Management of Postesophagectomy Respiratory Failure with Noninvasive Ventilation

“…We have reported the benefit of epidural analgesia on the improvement of anastomotic perfusion. 27,41 This could partly explain the protective influence of this technique after esophagectomy. Unfortunately, epidural analgesia could not be used in the case described here because of the patient's antiplatelet therapy.…”

“…The first step is to establish whether there is any involvement of surgical complications, such as anastomotic leakage, in particular with regard to the potential respiratory consequences. 27 This hypothesis requires that a surgeon be consulted; chest drainage discharge be examined for abnormalities; a methylene blue test through the nasogastric tube be carried out; computed tomography examinations of the chest be performed to identify mediastinitis or pleural empyema; and, if clinical status implies reintubation, a fibroscopic assessment of anastomotic status must be carried out. Once a surgical cause has been eliminated, the practitioners in charge of the patient need to promote respiratory rehabilitation with optimal analgesic control to ensure correct oxygenation.…”

Anaesthesia during oesophagectomy

“…TEA provides superior analgesia, reduces respiratory complications, need for postoperative mechanical ventilation, rehabilitations and hospital length of stay (26)(27)(28)(29)(30). Most studies show mainly an effect on pulmonary morbidity although a reduction in the incidence of anastomotic leakage has also been suggested (31). TEA has no clear anti-inflammatory effects (32).…”