[Perioperative management for esophagectomy]

Esophagetomy is considered as one of the most invasive surgical procedures. Despite marked advances in surgical techniques, anesthetic management and intensive care, the morbidity and mortality remain still high compared with the other types of surgery. Excessive inflammatory response after surgery induces over-production of inflammatory cytokines, leading to the development of vital organ failures. Anesthesiologists should pay much attention to perioperative management of patients undergoing esophagectomy since they are potentially at high risks of respiratory and cardiovascular complications caused by excessive stress with cervical, thoracic and abdominal procedures. During surgery, many interventions such as effective epidural anesthesia, restrictive fluid management, lung protective strategy, maintenance of hemodynamic stability and steroid therapy should be considered. Perioperative respiratory management including early extubation, intensive physical therapy, early mobilization and rehabilitation with enteral nutrition are all important to prevent postoperative complications and to shorten the length of hospital stay. However, some patients need longer-term mechanical ventilation due to preoperative respiratory dysfunction and reduced cough reflex by surgical manipulations. A multimodal treatment is warranted to improve the outcomes after esophagectomy.