[Esophageal carcinoma: 2-stage operation for preventing mediastinitis in high risk patients]

Strict patient selection, standardization of the surgical technique and advances in peri- and postoperative management have in experienced centers resulted in a decrease in postoperative mortality after esophagectomy and reconstruction to less than 5% in recent years. The previously common and potentially lethal pulmonary and cardiac complications have lost their impact on outcome. Today, septic complications, which usually arise from the reconstruction phase, constitute the major morbidity and mortality factors in the surgical therapy of esophageal cancer. These complications pose a particular problem for patients with compromised organ function and patients after neoadjuvant combined radiochemotherapy. In these situations a surgical safety concept with a two-stage procedure, i.e., delay of reconstruction after resection for 8-10 days, can markedly reduce the otherwise substantial postoperative mortality. A two-stage procedure thus offers patients a chance of a potentially curative surgical therapy who would otherwise be excluded from resection.