Several recent articles in the British Anesthesia literature detail the high risk of perioperative complications associated with esophagectomy. Some of the interest in this area is due to the British Report of the National Confidential Enquiry into Perioperative Deaths 1996/1997 . (London NCEPOD,1998) which pointed out the high rates of mortality associated with this operation.

Tandon et al describe a 44% incidence of pulmonary complications in these patients:
“Peri-operative risk factors for acute lung injury after elective oesophagectomy”
S. Tandon1, A. Batchelor1, R. Bullock1, A. Gascoigne1, M. Griffin2, N. Hayes2, J. Hing3, I. Shaw1, I. Warnell1 and S. V. Baudouin1,3
1Departments of Anaesthesia and Intensive Care Medicine, Newcastle upon Tyne NHS Trust, Newcastle upon Tyne, UK. 2Northern Oesophago-gastric Unit, Newcastle upon Tyne NHS Trust, Newcastle upon Tyne, UK. 3University Department of Surgical and Reproductive Sciences, University of Newcastle upon Tyne, UK*Corresponding author: Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK

Acute lung injury after oesophagectomy is well recognized but the risk factors associated with its development are poorly defined. We analysed retrospectively the effect of a number of pre-, peri- and post-operative risk factors on the development of lung injury in 168 patients after elective oesophagectomy performed at a single centre. The acute respiratory distress syndrome (ARDS) developed in 14.5% of patients and acute lung injury in 23.8%. Mortality in patients developing ARDS was 50% compared with 3.5% in the remainder. Features associated with the development of ARDS included a low pre-operative body mass index, a history of cigarette smoking, the experience of the surgeon, the duration of both the operation and of one-lung ventilation, and the occurrence of a post-operative anastomotic leak. Peri-operative cardiorespiratory instability (measured by peri-operative hypoxaemia, hypotension, fluid and blood requirements and the need for inotropic support) was also associated with ARDS. Acute lung injury after elective oesophagectomy is associated with intraoperative cardiorespiratory instability.

Br J Anaesth 2001; 86: 633–8

This article is accompanied by an Editorial:
Sherry, K.M. (2001).”How can we improve the outcome of oesophagectomy?”. Br J Anaesth 86: 611-613

A previous editorial emphasized the intraoperative problems with lung isolation in esophagectomy cases if fiberoptic bronchoscopy is not used to monitor placement of double-lumen tubes:
SH Pennefather and GN Russell
“Placement of double lumen tubes–time to shed light on an old problem.”
Br. J. Anaesth. 2000 84: 308-310.