ABSTRACT
Esophageal resection has undergone refinements over recent years, with improved outcomes. However, in-hospital mortality remains above 10% in developed countries and is below 5% in only a select group of hospitals. Morbidity remains high even in high-volume hospitals. We reviewed risk factors in esophageal resection. Pulmonary complications occur mainly in older patients and in those with pulmonary dysfunction, especially %FEV1 or hypoxia. Liver cirrhosis, squamous cell cancer, low patient volume, and cervical anastomoses also increase complication rates. Neoadjuvant chemoradiotherapy, which may be effective in squamous cell tumors, can also increase morbidity. The main cause of morbidity and mortality are pleuropulmonary complications. Also significant are anastomotic leak and esophageal conduit necrosis. A complex procedure such as esophageal resection is better served in specialized teams.
Subject(s)
Adenocarcinoma/surgery , Carcinoma, Squamous Cell/surgery , Esophageal Neoplasms/surgery , Esophagectomy , Intraoperative Complications , Postoperative Complications , Adenocarcinoma/drug therapy , Adenocarcinoma/mortality , Adenocarcinoma/radiotherapy , Age Factors , Aged , Antimetabolites, Antineoplastic/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/radiotherapy , Endoscopy , Esophageal Neoplasms/diagnostic imaging , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/mortality , Esophageal Neoplasms/radiotherapy , Esophagectomy/adverse effects , Esophagectomy/mortality , Fluorouracil/therapeutic use , Forced Expiratory Volume , Hospital Mortality , Humans , Neoadjuvant Therapy , Platinum Compounds/therapeutic use , Prognosis , Radiography, Thoracic , Radiotherapy Dosage , Risk Factors , Time Factors , Tomography, X-Ray ComputedABSTRACT
La cirugía del cáncer de esófago está más reglada, hecho que ha propiciado mejores resultados. No obstante, la mortalidad operatoria en países desarrollados supera el 10% y sólo un grupo selecto se acerca al 5%. La morbilidad es elevada incluso en centros experimentados. Hemos revisado factores de riesgo. Las complicaciones respiratorias son más habituales en presencia de edad avanzada y alteraciones de las pruebas respiratorias, sobre todo la de volumen máximo espirado en el primer segundo e hipoxia. Factores como la cirrosis hepática, tipo epidermoide, la poca casuística o la anastomosis cervical generan morbilidad adicional. La quimiorradioterapia neoadyuvante, quizás eficaz en tumores epidermoides, puede añadir más morbilidad. Las complicaciones pleuropulmonares ocupan el primer lugar de morbimortalidad operatoria, sin olvidar que la fístula anastomótica o la necrosis de la plastia obligan a tomar precauciones. La complejidad del tema hace concluir que la resección esofágica por cáncer debe restringirse a grupos con casuística suficiente (AU)
Esophageal resection has undergone refinements over recent years, with improved outcomes. However, in-hospital mortality remains above 10% in developed countries and is below 5% in only a select group of hospitals. Morbidity remains high even in high-volume hospitals. We reviewed risk factors in esophageal resection. Pulmonary complications occur mainly in older patients and in those with pulmonary dysfunction, especially %FEV1 or hypoxia. Liver cirrhosis, squamous cell cancer, low patient volume, and cervical anastomoses also increase complication rates. Neoadjuvant chemoradiotherapy, which may be effective in squamous cell tumors, can also increase morbidity. The main cause of morbidity and mortality are pleuropulmonary complications. Also significant are anastomotic leak and esophageal conduit necrosis. A complex procedure such as esophageal resection is better served in specialized teams (AU)
