Perioperative Management

With advances in surgical techniques, various perioperative management strategies have been introduced to reduce the risk of postoperative complications in patients with esophageal cancer. It is important to accurately evaluate the tolerability of esophagectomy and to perform appropriate perioperative management based on appropriate risk management. Enhanced Recovery After Surgery programs have been developed to minimize perioperative stress, reduce surgery-related complications, and promote postoperative recovery. Most patients with esophageal cancer are malnourished and sarcopenic at the time of cancer diagnosis; therefore, nutritional assessment and continuous perioperative nutritional intervention are necessary to improve postoperative short- and long-term outcomes. Several nutritional indicators, such as the Global Leadership Initiative on Malnutrition criteria, have been proposed and shown to not only predict postoperative complications but also to be associated with survival and cancer recurrence. Nutritional interventions, beginning as early as possible and continuing throughout the perioperative period, are recommended for malnourished patients with esophageal cancer. Prehabilitation to optimize and improve the patient’s physiological reserve before surgery would be reasonable to ensure a rapid return to an acceptable level of functional activity after highly invasive esophagectomy. The findings also emphasize the need for further research into the role of prehabilitation in enhancing outcomes in patients undergoing esophagectomy. Finally, it is essential that medical team members from various professions, including not only surgeons but also anesthesiologists, nurses, nutritionists, pharmacists, physiotherapists, dentists, psychologists, and others, participate in perioperative management that makes use of the characteristics and strengths of each profession.