Postoperative Critical Care for Esophageal Surgery

Esophageal carcinoma is the eighth most common cancer and the sixth leading cause of death from cancer. Despite advances and improvements in patient care and techniques, the incidence of esophageal adenocarcinoma is still high and survival remains poor in Western countries in comparison to other same-stage malignancies. Today, esophagectomies are associated with significant morbidity and mortality of 39% and 11%, respectively. Interval esophagectomy after adjuvant chemotherapy remains the gold standard for the treatment of resectable esophageal cancer patients up to stage II. Following surgery, patients who require invasive mechanical ventilation or continuous infusion of vasoactive medications or for whom anesthesiologists deem intensive care unit (ICU) care mandatory because of intraoperative course and comorbidities are admitted to the ICU. Minimally invasive surgery, novel techniques used to relief pain, and judicious administration fluids intraoperatively have resulted in immediate extubation after esophagectomy to be the norm instead exception for patients who are at low risk. Weaning within the first 24 h after esophagectomy and rehabilitation of respiration are needed based on the recommendations of postoperative recovery. Following esophagectomy, among pulmonary complications, acute lung injury (ALI), which is defined as acute-onset hypoxemia with radiographic pulmonary infiltrates findings without a detectable cause, has been reported. Systematic and pulmonary inflammation has been associated with ALI following esophagectomy. Using corticosteroids in patients who develop ALI after esophageal surgery requires attention. The roles of corticosteroids in acute respiratory distress syndrome following esophageal surgery have been comprehensively investigated. The useful effects of corticosteroids are in compliance with fibroproliferation as an early reaction to pulmonary injury. Postoperative critical care of patients undergoing esophagectomy due to esophageal cancer is of paramount importance in terms of morbidity and mortality. Postoperative care includes admission to intensive care units, extubation, weaning from mechanical ventilation, fluid management, and management of postoperative complications.