Cancer, Esophageal

Incidence in USA: 4.39:100,000 in white men, 2.0:100,000 in white women, 8.63/100,000 in African-American men, and 4.2:100,000 in black women.

Adenocarcinoma more common in white men, while SCC highest in black men.

Overall mortality rate is 4% (white) to 8% (black).

Reflux as a risk of aspiration.

Malnutrition with dehydration due to dysphagia.

Periop arrhythmias occur in 20–60% of cases.

Anastomotic leak most frequent surgical complication (9–10%).

Pulm compromise (25%) due to lung injury from preop chemo-/radiation therapy, chronic aspiration, extensive tobacco use, and ventilator-induced lung injury

Airway protection during induction and postop

Arrhythmia

Alcohol withdrawal syndrome

Hydration status/malnutrition

Primarily either SCC from the esophageal squamous epithelium or adenocarcinoma of gastric origin.

Median age of diagnosis is 67 y, with a long-standing Hx of tobacco and alcohol intake.

Dysphagia and weight loss are initial symptoms, often present for 3–4 mo.

Extensive local growth and lymphatic involvement before becoming widely disseminated.

SCC (mainly localized in the upper one-third of the esophagus) is associated with achalasia for >25 y, tobacco use, alcohol, and lack of aspirin and statin use.

Adenocarcinoma (mainly at GE junction) is associated with GERD, esophagitis (Barrett esophagus), and obesity.

Nutritional factors (red meat, poor vegetable intake, hot liquids) have been implicated.