Abstract
To date no therapy has been proven superior to esophagectomy for both cure and palliation of patients with local-regionally limited esophageal cancer. In patients with local-regionally advanced lesions neoadjuvant chemo or chemoradiotherapy is often given prior to esophagectomy. Early stage lesions may be best treated with resection alone. The primary goal of surgery is complete (R0) resection of the tumor and surrounding lymph nodes in order to maximize the opportunity for cure and minimize the likelihood of local recurrence. Repeatedly it has been confirmed that complete surgical resection is the most important prerequisite for long-term survival in patients with localized esophageal cancer. However, accomplishing this goal is easier for intramucosal tumors than it is for transmural tumors. Consequently, the surgical approach and extent of resection should be modified based on the extent of disease present in each patient. Currently, at our center we individualize the procedure to the patient and the disease stage using four main surgical options: vagal-sparing esophagectomy without lymphadenectomy, en bloc esophagectomy with thoracic and abdominal lymphadenectomy, transhiatal resection, or a minimally invasive (laparoscopic, thoracosocpic/laparoscopic or Ivor-Lewis) esophagectomy. Although few centers offer all four surgical options, each option likely has a place in the appropriate patient, and each offers potential advantages.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Akiyama H, Tsurumaru M, Kawamura T, Ono Y. Esophageal stripping with preservation of the vagus nerve. Int Surg. 1982;67:125–8.
Banki F, Mason RJ, DeMeester SR, et al. Vagal-sparing esophagectomy: a more physiologic alternative. Ann Surg. 2002;236:324–35. Discussion 35-6.
Peyre C, DeMeester SR, Rizzetto C, et al. Vagal-sparing esophagectomy: the ideal operation for intramucosal adenocarcinoma and Barrett’s with high-grade dysplasia. Ann Surg. 2007;246:665–74.
Maish MS, DeMeester SR. Endoscopic mucosal resection as a staging technique to determine the depth of invasion of esophageal adenocarcinoma. Ann Thorac Surg. 2004;78:1777–82.
Zehetner J, DeMeester SR, Hagen JA, et al. Endoscopic resection and ablation versus esophagectomy for high-grade dysplasia and intramucosal adenocarcinoma. J Thorac Cardiovasc Surg. 2011;141:39–47.
Hagen JA, DeMeester SR, Peters JH, Chandrasoma P, DeMeester TR. Curative resection for esophageal adenocarcinoma: analysis of 100 en bloc esophagectomies. Ann Surg. 2001;234:520–30. Discussion 30-1.
Altorki NMD, Skinner DMD. Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg. 2001;234:581–7.
Urba S, Orringer M, Turisi A, Iannetoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001;19:305–13.
Leers JM, DeMeester SR, Chan N, et al. Clinical characteristics, biologic behavior, and survival after esophagectomy are similar for adenocarcinoma of the gastroesophageal junction and the distal esophagus. J Thorac Cardiovasc Surg. 2009;138:594–602. Discussion 1-2.
Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248:549–56.
Rizzetto C, DeMeester SR, Hagen JA, Peyre CG, Lipham JC, DeMeester TR. En bloc esophagectomy reduces local recurrence and improves survival compared with transhiatal resection after neoadjuvant therapy for esophageal adenocarcinoma. J Thorac Cardiovasc Surg. 2008;135:1228–36.
Leers JM, Ayazi S, Hagen JA, et al. Survival in lymph node negative adenocarcinoma of the esophagus after R0 resection with and without neoadjuvant therapy: evidence for downstaging of N status. J Am Coll Surg. 2009;208:553–6.
Waterman TA, Hagen JA, Peters JH, DeMeester SR, Taylor CR, Demeester TR. The prognostic importance of immunohistochemically detected node metastases in resected esophageal adenocarcinoma. Ann Thorac Surg. 2004;78:1161–9. Discussion -9.
Johansson J, DeMeester TR, Hagen JA, et al. En bloc vs transhiatal esophagectomy for stage T3 N1 adenocarcinoma of the distal esophagus. Arch Surg. 2004;139:627–31. Discussion 31-3.
Peyre CG, Hagen JA, DeMeester SR, et al. Predicting systemic disease in patients with esophageal cancer after esophagectomy: a multinational study on the significance of the number of involved lymph nodes. Ann Surg. 2008;248:979–85.
Omloo JMT, Lagarde SM, Hulscher JBF, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007;246:992–1000. Discussion -1.
Sihvo EI, Luostarinen ME, Salo JA. Fate of patients with adenocarcinoma of the esophagus and the esophagogastric junction: a population-based analysis. Am J Gastroenterol. 2004;99:419–24.
Briel JW, Tamhankar AP, Hagen JA, et al. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 2004;198:536–41. Discussion 41-2.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
DeMeester, S.R. (2018). En Bloc Esophagectomy. In: Schlottmann, F., Molena, D., Patti, M. (eds) Esophageal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-91830-3_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-91830-3_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-91829-7
Online ISBN: 978-3-319-91830-3
eBook Packages: MedicineMedicine (R0)