Postoperative management after oesophagectomy: An evidence-based approach

Oesophagectomy is a complex surgical procedure that requires meticulous multidisciplinary care. The procedure, which typically requires multiple incisions, involves tumour resection and creation of a gastric conduit followed by its anastomosis to the remaining oesophagus in the thorax or the neck. Although respiratory failure is the leading cause of postoperative morbidity, non-invasive ventilation is frequently unfeasible. Special care is required to secure the multiple catheters and drains inserted during the procedure; accidental dislodgement of any of which may increase postoperative morbidity. Among the potential complications of this procedure, the anastomotic site is susceptible to ischaemia because of the limited blood supply of the gastric conduit from the right gastroepiploic artery. Conduit ischaemia and anastomotic leak are the most serious complications and may result in prolonged morbidity or mortality. Furthermore, patients with oesophageal tumours and dysphagia are frequently cachectic, prehabilitation may reduce the incidence of postoperative complications. Dietitian-prescribed intensive nutritional support may limit the extent of postoperative weight loss and the risk of severe complications.