Esophageal cancer resection is one of the most complex and risky of all surgical procedures, and not all patients are candidates for surgical treatment. Your surgeon will decide whether to perform a surgical resection and choose the appropriate type of resection based on your specific situation. If you had some underlying disease before the diagnosis of esophageal cancer, you will need a series of evaluations and preoperative treatments.
Pulmonary disease
Pulmonary complications are a common complication after esophagectomy. You are at higher risk for pulmonary complications after surgery if you have had chronic lung disease (such as chronic obstructive pulmonary disease, tuberculosis, etc.) before, or if you have features such as advanced age, heavy smoking, or if the esophageal lesion is above the level of the bulge (approximately the mid-esophagus). You will need some targeted treatment before surgery, such as, smoking cessation therapy (nicotine replacement therapy), bronchodilator therapy, nebulizer therapy, hormone therapy, and appropriate antibiotic therapy.
Liver disease
If you like to drink alcohol in general, or if you have chronic hepatitis or fatty liver disease, you may have varying degrees of cirrhosis. Some data show that patients with cirrhosis have a higher rate of postoperative mortality and complications. Therefore, it is necessary for you to have a thorough evaluation of your liver function before surgery and to give appropriate liver-protective treatment if necessary.
“Three highs”
If you have high blood pressure, diabetes (hyperglycemia), coronary artery disease (hyperlipidemia), or stroke, you are at higher risk for surgery than the average patient. The doctor will give you the appropriate preoperative preparation according to the specific situation. For example, patients with hypertension and diabetes need to control their blood pressure and blood sugar levels before surgery, and patients with coronary artery disease and stroke need to pay attention to anticoagulation therapy during the perioperative period (before and after surgery).
In addition, for patients without these underlying diseases, it is also recommended that you can stop smoking and drinking before the procedure, preferably with a dental cleaning.
Smoking cessation
Smokers have more secretions in their airways, and the pain after esophagectomy can cause you to involuntarily cough less to expel sputum, causing large amounts of airway secretions to become sticky and block the airway, leading to atelectasis and even lung infection.
Quitting smoking before surgery will help you:
- Return the heart and lungs to work as soon as possible after surgery;
- reduce the risk of postoperative infectious and thrombotic complications;
- Postoperative wound healing.
Scientific studies have confirmed that intensive preoperative smoking cessation reduces the incidence of overall postoperative complications by 58% and the incidence of wound complications by 69%, significantly improving surgical outcomes.
In the treatment of nicotine dependence due to smoking, face-to-face counseling plus nicotine replacement therapy is an effective method for long-term smoking cessation in surgical patients. However, the vast majority of general hospitals in this country are not equipped to intervene with you several weeks in advance to quit smoking. Therefore, we recommend that you be sure to proactively visit a smoking cessation clinic and receive nicotine replacement therapy, etc., before you are ready to undergo surgical treatment.
Quitting alcohol
Despite the lack of sufficient clinical evidence, physicians generally agree that preoperative abstinence from alcohol can help improve the risk of postoperative complications and also reduce the use of analgesic medications and reduce alcohol damage to the liver to protect liver function. You will need to be truthful about your past drinking, and your doctor will assess the appropriate preoperative alcohol withdrawal modality for you and give medications if necessary to avoid withdrawal symptoms.
Cleaning
Studies have confirmed that oral treatments, such as preoperative dental cleaning, can reduce the incidence of ventilator-associated pneumonia in critically ill patients after surgery.