Preoperative Cardiovascular Assessment and Perioperative Management of Patients with Esophageal Cancer

Esophageal cancer ranks as the sixth leading cause of death from cancer and the eighth most common cancer worldwide. While advances have been made in the management and treatment of esophageal cancer patients, esophagectomy remains the most effective treatment modality for this disease. However, this procedure comes with several serious postoperative complications, both cardiac and non-cardiac, such as pulmonary complications, anastomotic leakage, new-onset atrial fibrillation, venous thromboembolism, and myocardial infarction. The European Society of Cardiology guidelines on non-cardiac surgery classify esophagectomy as a high-risk surgery for cardiovascular complications, with an expected 1-month cardiovascular death or myocardial infarction risk exceeding 5%. In addition to the stage of esophageal cancer, the challenge of surgery and perioperative cardiovascular complications are important factors that contribute to morbidity and mortality associated with esophageal cancer surgery. Therefore, determining the patient’s cardiovascular risk before surgery is crucial for patient safety. Moreover, perioperative management is essential to reduce postoperative risk and improve patient survival and care. This section will emphasize preoperative cardiac risk assessment scores, risk assessment of ischemic and nonischemic heart disease, preoperative cardiac testing, and management of postoperative outcomes in esophageal cancer patients in detail.