Preoperative anesthetic evaluation and preparation in patients requiring esophageal surgery for cancer

Esophagectomy for carcinoma of the esophagus is associated with significant mortality and morbidity. Patients with esophageal cancer have frequently obstruction with dysphagia and they often develop malnutrition. In addition, patients can suffer from chronic aspiration leading to a poor preoperative respiratory status. Thorough preoperative evaluation is essential for assessing the operative risk in the individual patient. Respiratory and cardiac problems are the most common complications and assessment of surgical risk, preoperative performance status, particularly with regard to pulmonary and cardiac risk, is likely to be the most important factor. Clinical findings are more predictive of pulmonary complications than results of testing. Cardiac risk is evaluated according to the American College of Cardiology (ACC)/American Heart Association guidelines. With the identification of risk factors, patients undergoing esophageal surgery could be stratified. Appropriate preoperative risk-reduction strategies can be used to decrease morbidity and mortality rates associated with esophagectomy for cancer.