title: Strategies to reduce pulmonary complications after esophagectomy.
abstract: Esophagectomy, the surgical removal of all or part of the esophagus, is a surgical procedure that is associated with high morbidity and mortality. Pulmonary complications are an especially important postoperative problem. Therefore, many perioperative strategies to prevent pulmonary complications after esophagectomy have been investigated and introduced in daily clinical practice. Here, we review these strategies, including improvement of patient performance and technical advances such as minimally invasive surgery that have been implemented in recent years. Furthermore, interventions such as methylprednisolone, neutrophil elastase inhibitor and epidural analgesia, which have been shown to reduce pulmonary complications, are discussed. Benefits of the commonly applied routine nasogastric decompression, delay of oral intake and prophylactic mechanical ventilation are unclear, and many of these strategies are also evaluated here. Finally, we will discuss recent insights and new developments aimed to improve pulmonary outcomes after esophagectomy.
authors.affiliation: Teus J Weijs, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
authors.forename: Teus J
authors.initials: TJ
authors.lastname: Weijs
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
authors.forename: Grard A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
authors.forename: Misha D P
authors.initials: MD
authors.lastname: Luyer
mesh_terms: D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality; D006304:Health Status; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care; D016896:Treatment Outcome
keywords: Acute lung injury; Acute respiratory distress syndrome; Complications; Esophagectomy; Pneumonia