[Management of perioperative complications following tumor resection in the upper gastrointestinal tract].
BACKGROUND
Surgical resection of tumors of the upper gastrointestinal (GI) tract represent complex procedures and are still associated with a relevant morbidity and mortality. A targeted preoperative risk analysis and patient selection with consideration of the nutritional status and comorbidities are important in order to reduce the perioperative complication rate.


CONCLUSIONS
Anastomotic leaks still remain the most feared surgical complication and in addition to early recognition, immediate initiation of an appropriate therapy are essential. Conservative treatment can be considered for small and adequately drained fistulas as well as in cervical leakages. Indications for surgical reintervention are leaks that occur in the early postoperative course, fulminant defects with diffuse mediastinitis and conduit necrosis. The majority of anastomotic leaks can be successfully managed with minimally invasive endoscopic techniques, e.g. stent placement and endoluminal vacuum therapy. Delayed gastric emptying is frequently observed following esophageal resection and usually shows a satisfactory response to medicinal treatment and endoscopic interventions. The benefits of pyloroplasty in the primary intervention is still a matter of debate. Chylothorax is a rare but serious complication which should initially be managed with conservative measures.


CONCLUSIONS
For the successful management of postoperative complications following surgical resection of tumors of the upper GI tract both an interdisciplinary approach and the availability of an appropriate infrastructure with defined algorithms are of paramount importance. Therefore, a concentration of these procedures in specialized centers would be highly desirable.
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinik für Chirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland. frankbenedix@gmx.de.
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Benedix
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinik für Chirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland.
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Dalicho
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinik für Chirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland.
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Garlipp
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinik für Chirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland.
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Ptok
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinik für Chirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland.
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Arend
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Klinik für Chirurgie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Straße 44, 39120, Magdeburg, Deutschland.
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Bruns
D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002916:Chylothorax / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D042241:Early Diagnosis; D016629:Esophagectomy; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011707:Pyloric Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D041742:Upper Gastrointestinal Tract / Q000601:surgery*
Anastomotic leak; Chylothorax; Complications; Tumor resection; Upper gastrointestinal tract