Adequate Management of Postoperative Complications after Esophagectomy: A Cornerstone for a Positive Outcome

SIMPLE SUMMARY: Despite advances in the multimodal therapy of esophageal cancer, postoperative complications remain a challenge for surgeons and patients. Their prompt diagnosis and adequate treatment are essential for the further course of cancer therapy, ensuring an optimal outcome. The tumor biology was not found to be associated with a better or worse outcome when it comes to postoperative complications. In this review, we focus on up-to-date approaches to prevent and treat the major complications after esophagectomy for cancer. Among those are the anastomotic leak (AL), the esophago-respiratory fistula (ERF), and the chylothorax (CT). ABSTRACT: Background: Esophagectomy for cancer is one of the most complex procedures in visceral surgery. Postoperative complications negatively affect the patient’s overall survival. They are not influenced by the histology type (adenocarcinoma (AC)/squamous cell carcinoma (SCC)), or the surgical approach (open, laparoscopic, or robotic-assisted). Among those dreadful complications are anastomotic leak (AL), esophago-respiratory fistula (ERF), and chylothorax (CT). Methods: In this review, we summarize the methods to avoid these complications, the diagnostic approach, and new therapeutic strategies. Results: In the last 20 years, both centralization of the medical care, and the development of endoscopy and radiology have positively influenced the management of postoperative complications. For the purpose of their prevention, perioperative measures have been applied. The treatment includes conservative, endoscopic, and surgical approaches. Conclusions: Post-esophagectomy complications are common. Prevention measures should be known. Early recognition and adequate treatment of these complications save lives and lead to better outcomes.