Article ; Online: Anesthetic Management for Squamous Cell Carcinoma of the Esophagus.
Methods in molecular biology (Clifton, N.J.)
2020 Volume 2129, Page(s) 359–383
Abstract: While surgery plays a major role in the treatment and potential cure of esophageal cancers, esophagectomy remains a high-risk operation with significant perioperative morbidity and mortality compared to other oncosurgical procedures. Perioperative ... ...
| Abstract | While surgery plays a major role in the treatment and potential cure of esophageal cancers, esophagectomy remains a high-risk operation with significant perioperative morbidity and mortality compared to other oncosurgical procedures. Perioperative management for esophagectomy is complex, and close attention to detail in various areas of anesthetic and perioperative management is crucial to improve postoperative outcomes. Patients undergoing esophagectomy should be offered an evidence-based risk assessment for their postoperative outcomes to allow active participation and informed, shared-decision making. Novel perioperative risk scores have been developed to predict both short-term and long-term outcomes in patients with esophageal cancer, although independent validation of such scoring systems is still required. Apart from accurate preoperative risk assessment, further efforts to improve morbidity and mortality from esophagectomy is achieved through comprehensive Enhanced Recovery after Surgery (ERAS) protocols, which comprise an individualized bundle of care throughout the perioperative journey for each patient and should be implemented as a standard practice. Furthermore, anesthetic practice and perioperative anesthetic drug usage can potentially affect cancer progression and recurrence. This chapter reviews current evidence for various factors that contribute to the improvement of perioperative outcomes, including prehabilitation, preoperative optimization of anemia, thoracic epidural analgesia, intraoperative protective ventilatory strategies, goal-directed fluid therapy, as well as special attention to other perioperative issues that potentially reduce anastomotic and cardiopulmonary complications. In summary, it is difficult to show a measurable benefit from any one single intervention, and a multidisciplinary approach that encompasses multiple aspects of perioperative care is necessary to improve outcomes after esophagectomy. |
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| MeSH term(s) | Adenocarcinoma/pathology ; Anesthesia/methods ; Anesthetics/therapeutic use ; Carcinoma, Squamous Cell/pathology ; Esophageal Neoplasms/pathology ; Esophageal Squamous Cell Carcinoma/metabolism ; Esophageal Squamous Cell Carcinoma/pathology ; Esophageal Squamous Cell Carcinoma/surgery ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Esophagus/pathology ; Female ; Head and Neck Neoplasms/pathology ; Humans ; Male ; Mouth Neoplasms/pathology ; Perioperative Care/methods ; Postoperative Complications/etiology ; Risk Factors |
| Chemical Substances | Anesthetics |
| Language | English |
| Publishing date | 2020-02-13 |
| Publishing country | United States |
| Document type | Journal Article |
| ISSN | 1940-6029 |
| ISSN (online) | 1940-6029 |
| DOI | 10.1007/978-1-0716-0377-2_26 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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