(Summary table)
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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
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!Thoracoscopic
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![[Ivor Lewis esophagectomy|Ivor Lewis]]
!McKeown
![[Transhiatal esophagectomy|Transhiatal]]
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Revision as of 10:50, 2 September 2021

Esophagectomy
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
In development
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. 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)
  2. 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)
  3. 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)