Complications
The most common adverse effects of programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor therapies are: anemia (45.4%), fatigue (34.3%), dysphagia (30%), neutropenia (19.6%), lymphopenia (10.2%), hypertension (9.3%), and elevated lipase (7.2%).[253] Other potential adverse effects include colitis, myocarditis, pericarditis, and skin toxicities.
Guidelines for monitoring of patients and management of complications are available.[241][254]
This is the most common postoperative complication, occurring in as many as 25% of patients.[251] This is one of the most frequent causes of death in patients with esophageal cancer treated by surgery.
In patients with esophageal obstruction, aspiration may occur.
Reflux disease is considered an unavoidable consequence of esophageal resection followed by gastric interposition. Mucosal damage from acid and bile exposure in the esophageal remnant affects about 50% of these patients.[255]
This rare complication usually occurs with squamous cell carcinomas of the upper thorax, especially when they arise on the left side. They are almost always fatal but, rarely, a herald bleed may occur, thus allowing urgent surgery and graft placement.
Tracheoesophageal and bronchoesophageal fistulae are severe complications, which are most likely to occur with squamous cell lesions in the mid-esophagus. Treatment can involve either the airway or the esophagus or both.
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