Postoperative care after esophagectomy: the surgeon's view

Although in the past esophagectomy was associated with high rates of morbidity and mortality, currently specialized centers have reported reduced hospital death rates of less than 10%. This reduction has been mainly attributed to preoperative patient selection, improvements in anesthesia, surgical techniques, and postoperative care management. In recent years, clinical care pathways, namely physician-directed clinical plans, have been developed to standardize postoperative care after specific surgical procedures: primary goals are improvement in quality of care and reduction in hospital costs. These pathways could be planned after identification of the complications with the highest incidence and the highest hospital costs in order to optimally allocate resources. Aim of this study is to delineate an ideal clinical care pathway after esophagectomy by reporting the most common complications with an overview of advances in perioperative care and providing pointers to what might be achievable.