History Taking

Obviously a full history is necessary but the following points are particularly important:

Name 

Age - An important risk factor, old patients have a higher risk of mortality and morbidity, young patients tend to have more aggressive tumours.

Occupation - Gives a rough indication of the level of questioning and explanation you should give the patient, may also indicate the level of physical performance of the patient and possible exposure to noxious agents.

Who accompanies the patient - This may indicate the level of social support the patient has while recuperating from the operation in hospital and later on discharge.

Presenting complaint - Obviously this will be uppermost in the patients mind as the main problem.

Length history - This may reveal the underlying cause of the problem eg short history in tumours, long history in reflux disease, achalasia, and benign strictures.

Weight loss - An important point that gives an indication of the patients reserves for undergoing a big operation. Pre operative feeding has largely fallen from favor, and post operative TPN or jejunostomy feeding is not universally undertaken.

Bone pain - May indicate bone metastasis  or local invasion.

What can they actually eat and drink - This helps in the timing of surgery, and also is the patient able to undergo Neo-adjuvent chemotherapy.

Abdominal and back pain - May indicate local extent of the tumour signifying inoperability.

Bowels - Any large bowel pathology may render the large colon unusable as a replacement conduit.

Previous surgical history - Especially previous abdominal, thoracic and particularly gastric surgery.

Common medical conditions

Angina, previous CABG and valve surgery - Patients with these conditions are becoming increasingly common. unless the patient has unstable angina their is probably no role for  angiography and/or angioplasty and stenting, however review by a cardiologist to optimize anti anginal medication may be beneficial. Prior valve surgery is important if any remaining valve or ventricular dysfunction is present, and in the management of antibiotic prophylaxis and anticoagulation should this be necessary. A patient who is angina free with a good exercise tolerance who has had a prior CABG may present problems if a left sided above aortic arch or neck anastomosis is contemplated in a patient has has had a LIMA utilised.

COAD - Respiratory complications are the most common problem patients have after an oesophagectomy, measurement of FVC and FEV1 can help, but performance staus ie how far can the patient walk, can they do a flight of stairs is probably more valuable.

Thyroid - Dysfunction is relatively unimportant, however the presence of a goiter can make a neck anastomosis very difficult.

Diabetes - Obviously poses an increased risk of cardiovascular events, renal impairment / failure and infection, and anastomotic failure.

OTHERS

Blood pressure, previous myocardial infarctions, DVT / PE, epilepsy, jaundice, gout, TB, shingles, CVA /TIA, Rheumatic fever.

SPECIFIC CONDITIONS

Reflux disease

When do they get it, what is it like, how severe are the episodes, provocative factors, riskm factors eg obesity, what interventions have been tried already, what affect on their life does it have.

Ruptured  oesophagus

What caused it ? Iatrogenic, presenting complaint, how long ago did it occur, what confirmatory investigations have been performed. If iatrogenic what was been done - eg endoscopy in the investigation of dysphagia. If the patient has a tumour and a subsequent iatrogenic perforation they will / may need an emergency oesophagectomy if appropriate.