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.
KeywordsEsophageal cancer En bloc esophagectomy Thoracotomy Laparotomy Colonic interposition
- 11.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.CrossRefPubMedGoogle Scholar
- 18.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.Google Scholar