[Management of perioperative complications following tumor resection in the upper gastrointestinal tract]. / Management perioperativer Komplikationen nach Tumorresektionen im oberen Gastrointestinaltrakt.

BACKGROUND: Surgical resection of tumors of the upper gastrointestinal (GI) tract represent complex procedures and are still associated with a relevant morbidity and mortality. A targeted preoperative risk analysis and patient selection with consideration of the nutritional status and comorbidities are important in order to reduce the perioperative complication rate. RESULTS AND DISCUSSION: Anastomotic leaks still remain the most feared surgical complication and in addition to early recognition, immediate initiation of an appropriate therapy are essential. Conservative treatment can be considered for small and adequately drained fistulas as well as in cervical leakages. Indications for surgical reintervention are leaks that occur in the early postoperative course, fulminant defects with diffuse mediastinitis and conduit necrosis. The majority of anastomotic leaks can be successfully managed with minimally invasive endoscopic techniques, e.g. stent placement and endoluminal vacuum therapy. Delayed gastric emptying is frequently observed following esophageal resection and usually shows a satisfactory response to medicinal treatment and endoscopic interventions. The benefits of pyloroplasty in the primary intervention is still a matter of debate. Chylothorax is a rare but serious complication which should initially be managed with conservative measures. CONCLUSIONS: For the successful management of postoperative complications following surgical resection of tumors of the upper GI tract both an interdisciplinary approach and the availability of an appropriate infrastructure with defined algorithms are of paramount importance. Therefore, a concentration of these procedures in specialized centers would be highly desirable.

[Evidence base for minimally invasive esophagectomy for esophageal cancer]. / Evidenzlage zur minimalinvasiven Chirurgie beim Ösophaguskarzinom.

Surgery remains the mainstay of potentially curative treatment of esophageal cancer; however, esophageal resection is still associated with a relevant morbidity and mortality. Furthermore, patients frequently suffer from concomitant comorbidities and present in a reduced nutritional status. The rationale of minimally invasive surgery is the reduction of surgical trauma with subsequent minimization of (pulmonary) complications and mortality without compromising oncological quality. Minimally invasive esophageal resection was established nearly two decades ago and since then some centers worldwide have adopted this approach as the preferred option for surgical treatment of esophageal cancer. Minimally invasive esophageal resection can be safely performed and provides excellent results in experienced hands. Currently, there is only one randomized trial available comparing open and minimally invasive resection. It was demonstrated that the latter significantly reduced pulmonary complications with comparable mortality and oncological outcome. However, in the majority of studies these convincing results could not be confirmed. Reduced blood loss and a shortened hospital stay were shown to be the main advantages of the minimally invasive approach. Due to technical modifications, patient selection and a remarkable heterogeneity of current studies, a final conclusion on the value of minimally invasive esophagectomy is difficult to be drawn. Based on the current evidence, a noncritical use of minimally invasive resection for esophageal cancer cannot be recommended; however, in selected patients and with appropriate expertise this approach is at least comparable to open esophagectomy.