Management of post-esophagectomy functional disorders: a clinical practice review

Abstract

Esophagectomy remains the cornerstone of curative treatment for esophageal and gastroesophageal junction malignancies. While surgical techniques continue to evolve and perioperative mortality decreases, various complications may arise due to the altered upper gastrointestinal anatomy and loss of normal physiology after the procedure. These alterations manifest as post-esophagectomy functional disorders that significantly impact patient’s quality of life and long-term outcomes. The loss of normal esophageal function, vagal denervation, and altered anatomy creates multiple pathophysiologic mechanisms that often overlap, necessitating a comprehensive evaluation and multimodal management. Early recognition and intervention are key and can improve outcomes, with some sequelae being preventable through meticulous surgical techniques and standardized postoperative protocols. This comprehensive review examines the pathophysiology, clinical presentation, and management of these functional disorders. It highlights the unique challenges that these patients face after their esophagectomies, noting both the short- and long-term problems. By providing an overarching framework for the development of post-esophagectomy functional disorders, this review aims to lay out the evidence-based strategies and recommendations for prevention, diagnosis and treatment. Understanding these changes that occur after surgery is essential for clinicians managing the growing population of esophagectomy survivors, not only for oncologic follow-up but also for proper detection and management of functional complications.