Consensus guidelines for thoracic surgical patient management—do they represent the consensus?

Definitive surgery for esophageal cancer is associated with a high rate of postoperative complications. For instance, in the NSQIP database (2008 to 2017), the average rate of 30-days mortality and overall morbidity after a 3-field esophagectomy (CPT 43112) is 2.7% and 47.4%. Further, pulmonary complications (pneumonia, prolonged intubation and reintubation within 72 hours) occur with a rate of 26.0%, and infectious complications (superficial, deep, organ space surgical site infections, dehiscence, sepsis) occur with a rate of 23.6%. These are 2.6%, 42.3%, 23.1%, and 16.8% after Ivor Lewis esophagectomy (CPT 43117), and 2.5%, 44.0%, 25.1%, and 22.0% after transhiatal esophagectomy (CPT 43107) (1). Thus, these are one of the cruxes of esophagectomy.