title: Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk.
abstract: Minimally invasive (MI) esophageal resection (ER) has the theoretical advantage of reduced postoperative complications compared with standard ER. However, the impact of MIER on rates and severity of pulmonary complications is unclear. Four patients underwent laparoscopic gastroesophageal mobilization and resection followed by gastric pull-up and cervical esophageal anastomosis (MIER). Videofluoroscopic swallowing studies (VFSS) assessed pharyngolaryngeal function postoperatively. All postoperative complications were documented. Each MIER was completed successfully without intraoperative complications. Mean operative time was 4.3 +/- 2 h. Postoperatively, VFSS detected laryngeal penetration, vocal cord paralysis, and/or aspiration in three patients, two of whom experienced severe respiratory complications. MIER patients are susceptible to aspiration, likely due to transient denervation of the pharynx and laryngeal structures. Following MIER, aggressive pulmonary toilet and aspiration precautions are emphasized to reduce pulmonary complications. Furthermore, serial evaluation of deglutition is encouraged to guide the safe and appropriate resumption of oral feeding.
authors.affiliation: Department of Surgery, Wilford Hall USAF Medical Center, San Antonio, Texas 78236-5300, USA. bz.atkins@duke.edu
authors.forename: B Zane
authors.initials: BZ
authors.lastname: Atkins
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Fortes
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Watkins
mesh_terms: D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000293:injuries; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D011015:Pneumonia, Aspiration / Q000209:etiology; D011183:Postoperative Complications; D012119:Respiration; D012140:Respiratory Tract Diseases / Q000209:etiology*; D012307:Risk Factors