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Complications of esophageal resection

Daniel P Raymond, MD
Section Editor
Joseph S Friedberg, MD
Deputy Editor
Wenliang Chen, MD, PhD


Operations that resect the esophagus and restore gastrointestinal continuity are technically challenging procedures. The rates for morbidity and mortality depend on many factors (eg, patient comorbidities, operative approach, hospital/surgeon volume) but vary widely between publications. A review of all publications between 2005 and 2009 found that no single complication was reported in all papers, and in-hospital mortality, the most common term for postoperative death, had six different definitions [1].

The systemic and procedure-specific complications of esophageal resection are reviewed here. Methods by which surgical resection is accomplished are reviewed separately. (See "Surgical management of resectable esophageal and esophagogastric junction cancers".)


The overall incidence of postoperative complications varies widely between 20 and 80 percent and includes systemic complications (eg, pneumonia, myocardial infarction) and complications specific to the surgical procedure (eg, anastomotic leaks, recurrent laryngeal nerve injury) [2-13]. Pulmonary complications are the most common postoperative complications, occurring in 16 to 67 percent of patients [7,14-16], but anastomotic leak is the most dreaded, occurring in 0 to 40 percent of patients [7,17,18]. (See 'Anastomotic leak' below and 'Pulmonary' below.)

A multivariate analysis identified several preoperative factors that increased the risk of complications following esophageal resection and reconstruction [3]. Some of these included increasing age, conditions associated with compromised pulmonary function (eg, chronic obstructive pulmonary disease), malnutrition, renal or hepatic dysfunction, and emergency surgery. The preoperative indication for surgery (ie, malignant or benign disease) was not associated with increased morbidity. Patients with malignant disease had similar 30-day morbidity rates compared with patients with benign disease (49.0 versus 51.1 percent).

Comorbid illnesses increase the risk of postoperative complications (eg, cardiorespiratory complications, anastomotic leakage, reoperation rates, wound infection) and death following esophagectomy [8,19,20]. As an example, in a prospective study of 615 patients, those with comorbid illness had an increased overall rate of postoperative complications or major anastomotic leaks compared with patients without comorbidities (28 versus 18 percent and 11 versus <1 percent, respectively) [8]. In addition, a metaregression from a separate study showed the risk of anastomotic leakage or atrial fibrillation in obese patients with diabetes was significantly higher compared with obese patients without diabetes [19].

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Literature review current through: Oct 2017. | This topic last updated: Jun 06, 2017.
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