Postoperative complications after minimally invasive esophagectomy in the prone position: any anesthesia-related factor?

Abstract

Objective: To evaluate the incidence of postoperative complications arising within 30 days of minimally invasive esophagectomy in the prone position with total lung ventilation and their relationship with 30-day and 1-year mortality. Secondary outcomes included possible anesthesia-related factors linked to the development of complications. Methods: The study is a retrospective single-center observational study at the Anesthesia and Surgical Department of a tertiary care center in the northeast of Italy. Patients underwent cancer resection through esophagectomy in the prone position without one-lung ventilation. Results: We included 110 patients from January 2010 to December 2017. A total of 54% of patients developed postoperative complications that increased mortality risk at 1 year of follow-up. Complications postponed first oral intake and delayed patient discharge to home. Positive intraoperative fluid balance was related to increased mortality and the risk to develop postoperative complications. C-reactive protein at third postoperative day may help detect complication onset. Conclusions: Complication onset has a great impact on mortality after esophagectomy. Some anesthesia-related factors, mainly fluid balance, may be associated with postoperative mortality and morbidity. These factors should be carefully taken into account to obtain better outcomes after esophagectomy in the prone position without one-lung ventilation.

Perioperative Risk Factors for Postoperative Pulmonary Complications After Minimally Invasive Esophagectomy

“… 32 , 33 A recent retrospective study found that blood cell transfusion has an OR of 2.02 for the development of postoperative complications in patients undergoing MIE. 34 In the present study, the PPCs group also had higher incidences of non-pulmonary complications than the non-PPCs group. Therefore, it is unclear whether the risk of development of PPCs was caused by transfusion or was related to a higher incidence of non-pulmonary complications.…”

High flow nasal oxygen vs. conventional oxygen therapy over respiratory oxygenation index after esophagectomy: an observational study

“…More evidence is needed in this regard. Evidence highlights that postoperative complication worsens patient outcomes ( 36 ).…”

Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint

“…Depending on the specific surgical program, the patient's position (supine, lateral decubitus or prone) and the type of surgery (with or without a thoracotomy), two principal aspects need to be taken into account. First, we know that an intraoperative fluid volume >4 litres and higher fluid balances on post-operative day 1 are independent risks factors for PPCs, with a 16% increase in the risk of postoperative symptoms for each additional litre and a 32% increase in the probability of PPCs after esophagectomy (71)(72)(73). Second, the restrictive fluid approach should not be translated as tout court in this type of surgery.…”

“…So, transfusions are rarely needed nowadays (93). In addition, various studies have demonstrated that perioperative red blood cell (RBC) transfusions are associated with more postoperative complications and a higher risk of death after esophagectomy (71,94,95). RBC administration is only advisable for Hb levels <7 g/dL in the absence of cardiac disease and with normal organ perfusion parameters (lactate levels within normal range, adequate urine output, normal S c VO 2 and hemodynamic stability).…”