• Pritam Singh, James Gossage, Sheraz Markar, Philip H Pucher, Alex Wickham, Jonathan Weblin, Swathikan Chidambaram, Alexander Bull, Oliver Pickering, Monty Mythen, Nick Maynard, Mike Grocott, Tim Underwood, and AUGIS/POQI Pulmonary Consensus Group .
• Department of General Surgery, Royal Surrey NHS Foundation Trust, Surrey, UK.
• Br J Surg. 2022 Oct 14; 109 (11): 109611061096-1106.

BackgroundPulmonary complications are the most common morbidity after oesophagectomy, contributing to mortality and prolonged postoperative recovery, and have a negative impact on health-related quality of life. A variety of single or bundled interventions in the perioperative setting have been developed to reduce the incidence of pulmonary complications. Significant variation in practice exists across the UK. The aim of this modified Delphi consensus was to deliver clear evidence-based consensus recommendations regarding intraoperative and postoperative care that may reduce pulmonary complications after oesophagectomy.MethodsWith input from a multidisciplinary group of 23 experts in the perioperative management of patients undergoing surgery for oesophageal cancer, a modified Delphi method was employed. Following an initial systematic review of relevant literature, a range of anaesthetic, surgical, and postoperative care interventions were identified. These were then discussed during a two-part virtual conference. Recommendation statements were drafted, refined, and agreed by all attendees. The level of evidence supporting each statement was considered.ResultsConsensus was reached on 12 statements on topics including operative approach, pyloric drainage strategies, intraoperative fluid and ventilation strategies, perioperative analgesia, postoperative feeding plans, and physiotherapy interventions. Seven additional questions concerning the perioperative management of patients undergoing oesophagectomy were highlighted to guide future research.ConclusionClear consensus recommendations regarding intraoperative and postoperative interventions that may reduce pulmonary complications after oesophagectomy are presented.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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