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Morbid-Mortality and Treatment of Complications

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Adenocarcinoma of the Esophagogastric Junction

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Abstract

Despite the growing importance of chemotherapy and radiotherapy, surgery is still the preferred curative treatment for esophageal adenocarcinoma. Depending on the esophageal and gastric involvement of this tumor, a gastrectomy or an esophagectomy is required. The latter needs an abdomino-thoracic approach or a gastric pull-up, resulting in an increased morbidity and mortality.

EAC surgery is a major operation, highly demanding for the patient that is often already strained by the disease and by neoadjuvant treatments. Consequently the clinical status has to be analyzed when electing a patient for surgical resection, trying to identify patients at high risk before surgery in order to perform targeted perioperative treatments.

Morbidity can be mainly divided in medical and surgical. Medical complications include cardiac and respiratory complications, the latter being the most frequent occurring in 21–27 % of patients. Main surgical complications are anastomotic leak, necrosis of the gastric conduit, and chylothorax. Among these anastomotic leaks represents the main surgical complication, with percentages that stand between 3.7 % and 14 %.

In recent years many studies have demonstrated a reduction up to four times in postoperative mortality in high volume centers. However, morbidity remains significant even in these centers, with percentages that range between 40 and 60 %. These results highlight how complications are bound to occur due to the technical complexity of this operation. Therefore, better “know-how” in managing postoperative complications can lead to a higher percentage of resolutions, significantly reducing postoperative mortality.

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Authors and Affiliations

  1. Upper Gastro-Intestinal Surgery Division, Department of Surgery, University of Verona, Verona, Italy

    Jacopo Weindelmayer

  2. Upper Gastrointestinal and General Surgery, University of Verona, Verona, Italy

    Simone Giacopuzzi, Andrea Zanoni & Giovanni de Manzoni

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  1. Jacopo Weindelmayer
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  2. Simone Giacopuzzi
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  1. Upper Gastrointestinal and General Surgery, University of Verona, Verona, Italy

    Simone Giacopuzzi

  2. Upper Gastrointestinal and General Surgery, University of Verona, Verona, Italy

    Andrea Zanoni

  3. Upper Gastrointestinal and General Surgery, University of Verona, Verona, Italy

    Giovanni de Manzoni

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Weindelmayer, J., Giacopuzzi, S., Zanoni, A., de Manzoni, G. (2017). Morbid-Mortality and Treatment of Complications. In: Giacopuzzi, S., Zanoni, A., de Manzoni, G. (eds) Adenocarcinoma of the Esophagogastric Junction. Springer, Cham. https://doi.org/10.1007/978-3-319-28776-8_18

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