[Consequences of the bilateral vagus nerve section at a cervical level]

Peri-operative and complication management for adenocarcinoma of the oesophagus and oesophagigastric junction

Surgical resection of oesophageal cancer still offers the only chance of cure for this disease. Nevertheless, oesophageal surgery may be accompanied by relevant mortality and morbidity, the causes of which can be both directly related to surgical technique as well as a large spectrum of non-surgical complications. In the last few years, improvements in patient selection and technical advances, as well as elaborated peri- and post-operative management, have helped to reduce these threats.The following article addresses important aspects of patient selection and evaluation, pre-operative preparation, anaesthesia, operative prophylaxis of complications, immediate post-operative care and complication management. All these factors are important contributions to improve the outcome in this challenging medical condition. Nowadays, experienced centres report operative mortality rates of around 5% for radical transthoracic resections (Low et al. 2007; Or-ringer et al. 2007; Ando et al. 2000; Karl et al. 2000; Whooley et al. 2003), down from rates of up to 30 or 40% in previous decades (Earlam and Cunha-Melo 1980). Many factors have contributed to these improvements; some authors claim large volume centres have a tendency to improve results, mostly due to more aggressive management of post-operative complications (Forshaw et al. 2006; van Lanschot et al. 2001; Smith et al. 2008). The following article summarizes the factors that have been identified in the past decades to influence the outcome of major surgery for the resection of adenocarcinoma of the oesophagus.