Difference between revisions of "Esophagectomy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = DLT / SLT + Bronchial blocker | ||
| lines_access = | | lines_access = Large bore PIV | ||
| monitors = | NGT | ||
Arterial Line | |||
| monitors = Standard monitors | |||
Invasive hemdynamic | |||
+/- Flowtrack | |||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = One-lung ventilation | ||
| considerations_postoperative = | | considerations_postoperative = Aspiration | ||
Vocal cord paresis | |||
Recurrent laryngeal nerve injury | |||
Operative mortality | |||
}} | }} | ||
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|+ | |+ | ||
! | ! | ||
! | !Open | ||
! | !Thoracoscopic | ||
!Robotic | |||
![[Ivor Lewis esophagectomy|Ivor Lewis]] | |||
!McKeown | |||
![[Transhiatal esophagectomy|Transhiatal]] | |||
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|Unique considerations | |Unique considerations | ||
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|Position | |Position | ||
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|Surgical time | |Surgical time | ||
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|EBL | |EBL | ||
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|Postoperative disposition | |Postoperative disposition | ||
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|Pain management | |Pain management | ||
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|Potential complications | |Potential complications | ||
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Revision as of 09:50, 2 September 2021
| Anesthesia type |
General |
|---|---|
| Airway |
DLT / SLT + Bronchial blocker |
| Lines and access |
Large bore PIV NGT Arterial Line |
| Monitors |
Standard monitors Invasive hemdynamic +/- Flowtrack |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
One-lung ventilation |
| Postoperative |
Aspiration Vocal cord paresis Recurrent laryngeal nerve injury Operative mortality |
| Article quality | |
| Editor rating | |
| User likes | 0 |
An esophagectomy remains a formidable surgery with high morbidity and mortality.[1] It is performed for esophageal cancer and non-malignant conditions including hiatal hernias, severe GERD refractory to medical management, esophageal strictures and diverticula, and dysmotility disorders such as achalasia.[1] Anesthetic management may contribute to the improvement of perioperative outcomes; such factors include prevention of tracheal aspiration, lung protective ventilatory strategies, thoracic epidural analgesia, judicious fluid management to optimize tissue oxygen delivery, and attention to issues that may reduce anastomotic complications.[2]
Esophageal cancer incidence has been increasing and is now the eighth most common malignancy worldwide. Despite overall poor prognosis with this malignancy, surgery plays a significant role to increase long-term survival and possible cure. Multiple variations of surgical approaches are described in the literature including Ivor Lewis (IL)[3], McKeown, and transhiatal (TH). While an open approach was used traditionally, surgeons have more recently favored minimally invasive, thoracoscopic, approaches including robotic techniques. Minimally invasive approaches allow for direct visualization within the thoracic cavity to reduce chances of injury during dissection and have reduced the pulmonary complications and hastened the recovery period.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Respiratory | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Open | Thoracoscopic | Robotic | Ivor Lewis | McKeown | Transhiatal | |
|---|---|---|---|---|---|---|
| Unique considerations | ||||||
| Position | ||||||
| Surgical time | ||||||
| EBL | ||||||
| Postoperative disposition | ||||||
| Pain management | ||||||
| Potential complications |
References
- ↑ 1.0 1.1 Ng, Ju-Mei (2008-06). "Perioperative Anesthetic Management for Esophagectomy". Anesthesiology Clinics. 26 (2): 293–304. doi:10.1016/j.anclin.2008.01.004. ISSN 1932-2275. Check date values in:
|date=(help) - ↑ Jaeger, J. Michael; Collins, Stephen R.; Blank, Randal S. (2012-12). "Anesthetic Management for Esophageal Resection". Anesthesiology Clinics. 30 (4): 731–747. doi:10.1016/j.anclin.2012.08.005. ISSN 1932-2275. Check date values in:
|date=(help) - ↑ Lewis, I. (1946-07). "The surgical treatment of carcinoma of the oesophagus; with special reference to a new operation for growths of the middle third". The British Journal of Surgery. 34: 18–31. doi:10.1002/bjs.18003413304. ISSN 0007-1323. PMID 20994128. Check date values in:
|date=(help)