Postoperative management of elective esophagectomy for cancer

Postoperative management after elective esophagectomy for cancer has not been standardized. Thoracoabdominal incision with associated pain, extended operative time with consequent extracellular fluid shifts, single lung ventilation, potential for prolonged postoperative mechanical ventilation and comorbidities in patients with esophageal cancer, all contribute to high perioperative risk. Respiratory problems remain the major cause of both mortality and morbidity after esophagectomy for cancer. A specific pulmonary disorder, acute respiratory distress syndrome (ARDS) occurs in 10-20% of patients after esophagectomy. ARDS mortality exceeds 50%. Atrial fibrillation, that complicates recovery in 20 to 25% of patients after esophagectomy, contributes to make outcome worse. Anesthesiologists should adopt strategies known to be able to optimize patient outcome. Decreased postoperative mortality and morbidity have been associated with epidural analgesia, bronchoscopy to clear persistent bronchial secretions, intraoperative fluid restriction and early extubation. It has been shown that setting up early respiratory physiotherapy and mobilitation may improve functional recovery.