Prevention and management of postoperative complications of high cardia lower esophageal cancer Wang Gangcheng, Department of General Surgery, Henan Cancer Hospital Wang Gangcheng, Department of General Surgery, Henan Cancer Hospital The lower esophageal segment of high cardia cancer is invaded, and after tumor resection, the esophageal jejunal anastomosis is mostly in the mediastinum, and if operated transabdominally, the anastomosis reinforcement is mostly difficult. Postoperatively, anastomotic leakage of the anastomosis is likely to occur. If anastomotic leak occurs in this area, it mostly leaks into the thoracic cavity. If not handled properly, septic chest infection may occur, and the anastomosis and surrounding blood vessels may be corroded, resulting in anastomotic hemorrhage and life-threatening. I operate on dozens of cases of invasive lower esophagus of high cardia cancer every year, and a certain number of anastomotic leaks also occur. Due to proper treatment, there are no patients with persistent septic chest infection and hemorrhage, and most of them are basically cured after one month of treatment, and the treatment experience is as follows: 1. If the esophageal dissection position is high, the diaphragm must be cut to ensure the quality of anastomosis. If the esophageal dissection is high, barely anastomosis, easily tear the broken end of the esophagus and the anastomosis may not be complete. If the chest is not opened, opening the diaphragm can also expose the space to meet the requirement of 7 cm anastomosis on the cardia, but the diaphragm must be cut adequately. If the esophageal dissection exceeds the distance of 7 cm above the cardia, open-chest anastomosis is recommended. 2. 2. If the esophageal dissection is high and the anastomosis is in the mediastinum, it is recommended to cut the diaphragm to place a chest tube. Experience from previous cases suggests that the anastomosis is within the mediastinum, even if the pleura is not broken, postoperative local fluid accumulation may easily lead to anastomotic leak and leakage into the thoracic cavity. It is recommended to place a chest tube directly intraoperatively. 3. Intraoperatively, three measures of “stopping the reflux of digestive fluid, jejunostomy, and placing intestinal nutrition through the abdominal wall” were adopted and treated as postoperative anastomotic leak. (For specific measures, see the previous article “Clinical strategies and operational techniques for preventing high-risk complications of high-grade esophageal-jejunal anastomotic leak…”) (http:///zhuanjiaguandian/wanggangcheng_2813755405.htm) 4. Postoperative chest radiographs should be taken every three days to check whether there is fluid in the chest cavity. For patients with high intraoperative anastomotic position, barely anastomosis, and no chest tube placed, a chest radiograph should be performed 3 days after surgery, and if a pleural effusion is found to be more suggestive of anastomotic leak, a chest tube should be placed in time for drainage. 5. A mediastinal drainage tube should be placed intraoperatively. In the past, gastric tubes were often placed instead of mediastinal tubes. With clinical observation, mediastinal tubes can be placed with abdominal tubes and placed for at least one week.