Approaches to Perioperative Care for Esophagectomy

DESPITE ITS LONGSTANDING RECOGNITION, esophageal carcinoma remains a highly lethal disease that affects thousands of patients annually. The United States Centers for Disease Control and Prevention reports heterogenous development of mortality from esophageal cancer over time (Fig 1). Although improvements over time have been made in the mortality rates of black women and men, the mortality for white men actually has increased in the last decade of the 20th century. In 2010, death rates from esophageal cancer were approximately 40/100,000 for men Z 65 years of age and about 10/100,000 for women Z 65 years of age. In 1990, death rates were significantly higher for black than for white patients; in 2010 the death rates were similar (Fig 1). Perioperative mortality for esophagectomy is the highest among elective procedures, and has been reported from 1% to 3% in contemporary single-center studies and between 3.4% high-volume hospitals and 17.3% in low-volume hospitals in a large multicenter retrospective study assessing cancer outcomes from 1984 to 1993 in patients older than 65. A recent study looking at trends and outcomes of esophageal surgery in the United States examined the national inpatient sample database to analyze results for patients with esophageal cancer treated with either total or partial esophagectomy. Between 2001 and 2010 in the United States, 15,190 esophagectomies were performed. Although numbers increased progressively during this period, mortality decreased from 8.3% to 4.2%.