Rays
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Postoperative management after elective esophagectomy for cancer has not been standardized. Thoracoabdominal incision with associated pain, extended operative time with consequent extracellular fluid shifts, single lung ventilation, potential for prolonged postoperative mechanical ventilation and comorbidities in patients with esophageal cancer, all contribute to high perioperative risk. Respiratory problems remain the major cause of both mortality and morbidity after esophagectomy for cancer. ⋯ Anesthesiologists should adopt strategies known to be able to optimize patient outcome. Decreased postoperative mortality and morbidity have been associated with epidural analgesia, bronchoscopy to clear persistent bronchial secretions, intraoperative fluid restriction and early extubation. It has been shown that setting up early respiratory physiotherapy and mobilitation may improve functional recovery.
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Esophageal cancer is essentially a disease of the elderly. Several studies suggested that age per se should not be considered a risk factor for surgical mortality and morbidity, and access to surgical treatment should not be denied only on the basis of age. ⋯ Therefore, a careful preoperative assessment of these factors, with particular regard to comorbid conditions (such as cardiovascular and pulmonary diseases), the physiological status, and social habits is necessary in elderly adults. In consideration of the need of a multidisciplinary assessment to identify comorbidities and operative risk, a close collaboration of pneumologists, cardiologists, radiologists, oncologists, thoracic surgeons, anesthesiologists, geriatric specialists, physical therapists is highly recommendable.