Consent: Oesophagectomy

Note: This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines.

Overview of Procedure

An oesophagectomy is the removal of all or part of the oesophagus through an incision in the abdomen and chest, with the remaining oesophagus anastomosed to the stomach. In many cases the abdomen is done laparoscopically and the chest open.

A small number of centres do both phases using minimally invasive techniques (laparoscopy / thoracoscopy).

Fig 1 – Oesophagectomy; removal of all or part of the oesophagus, with the remaining oesophagus anastomosed to the stomach.

Complications

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Damage to any of the surrounding structures and blood vessels around the oesophagus may occur  
Injury to surrounding structures including bowel, spleen, lung, airway In order to obtain good oncological clearance, the coeliac axis, tracheal bifurcation, and peri-aortic tissues are cleared and the lymph nodes removed, which inevitably means the adjacent structures are at risk.  
Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain   Most patients will receive a thoracic epidural, inter-vertebral block, or a patient-controlled analgesia
Infection Respiratory infection is the most common complication after oesophagectomy, occurring in around 30% of patients. Intra-abdominal infections are rare but serious complications that require further washout.  
Anastomotic leak (5 – 8%) This is a very serious complication occurring in around 10% of patients. It can be treated conservatively but may require further laparotomy, washout, and re-anastomosis.  
Chyle Leak (~3%) This is due to damage of the thoracic duct (usually from a bifid system) and may require re-thoracotomy.  
Re-operation (~10%) Re-laparotomy, re-thorocotomy, or endoscopy may be required to investigate or treat any of the complications above.  
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery; the mortality rate is around 4%  

 

Late

Complication Description of Complication Potential Ways to Reduce Risk
Recurrence There is always a potential for further surgery due to recurrence of tumour for example, and incisional hernias Avoid heavy lifting for 6 weeks.
Weight loss and reduced nutrition Reduced oral intake, with metabolic and endocrine changes, result in significant effects to nutritional status The involvement of a specialist dietician in the post-operative management is essential, often requiring nutritional support for an extended period

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