Universität zu Köln

Lambertz, R., Drinhaus, H., Schedler, D., Bludau, M., Schroeder, W. and Annecke, T. (2016). Perioperative management of transthoracic oesophagectomies. Fundamentals of interdisciplinary care and new approaches to accelerated recovery after surgery. Anaesthesist, 65 (6). S. 458 - 467. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1432-055X

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Abstract

Locally advanced carcinomas of the oesophagus require multimodal treatment. The core element of curative therapy is transthoracic en bloc oesophagectomy, which is the standard procedure carried out in most specialized centres. Reconstruction of intestinal continuity is usually achieved with a gastric sleeve, which is anastomosed either intrathoracically or cervically to the remaining oesophagus. This thoraco-abdominal operation is associated with significant postoperative morbidity, not least because of a vast array of pre-existing illnesses in the surgical patient. For an optimal outcome, the careful interdisciplinary selection of patients, preoperative risk evaluation and conditioning are essential. The caseload of the centres correlates inversely with the complication rate. The leading surgical complication is anastomotic leakage, which is diagnosed endoscopically and usually treated with the aid of endoscopic procedures. Pulmonary infections are the most frequent non-surgical complication. Thoracic epidural anaesthesia and perfusion-orientated fluid management can reduce the rate of pulmonary complications. Patients are ventilated protecting the lungs and are extubated as early as possible. Oesophagectomies should only be performed in high-volume centres with the close cooperation of surgeons and anaesthesia/intensive care specialists. Programmes of enhanced recovery after surgery (ERAS) hold further potential for the patient's quicker postoperative recovery. In this review article the fundamental aspects of the interdisciplinary perioperative management of transthoracic oesophagectomy are described.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lambertz, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Drinhaus, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schedler, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bludau, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Annecke, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-273425
DOI:	10.1007/s00101-016-0179-y
Journal or Publication Title:	Anaesthesist
Volume:	65
Number:	6
Page Range:	S. 458 - 467
Date:	2016
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1432-055X
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ONE-LUNG VENTILATION; PREOPERATIVE RISK ANALYSIS; STROKE VOLUME VARIATION; ESOPHAGEAL CANCER; EPIDURAL ANALGESIA; SURGICAL-TREATMENT; OUTCOMES; COMPLICATIONS; ANESTHESIA; CARCINOMA Multiple languages Anesthesiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27342