Complications following oesophagectomy, a review with future perspectives

Oesophagectomy with gastric tube reconstruction is a complex, high-risk surgical procedure. Despite improvements in surgical techniques and perioperative care, the postoperative course is often complicated. The two most frequent and important complications following oesophagectomy are anastomotic failure and pulmonary morbidity. Along with surgical methods, microvascular blood flow is an important factor in the development of anastomotic failure. Location of the anastomosis, tissue supportive techniques and early detection of anastomotic leakage may contribute to a decrease in morbidity. The pathogenesis of pulmonary complications is multifactorial. Prolonged systemic inflammatory response syndrome responses are associated with pulmonary complications. The cholinergic anti-inflammatory pathway may play a role in this inflammatory response and future research in this direction is necessary in the search for better care. In our opinion, only clinical pathways that include early extubation, fluid management, pain management and early mobilization and nutrition, are providing opportunities for fewer postoperative pulmonary complications. However, clinical pathways succeed only if surgeons, anaesthetists and intensivists feel they are part of the treatment process and take responsibility as a team for all complications.