Malignant: Esophageal Cancers
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Worldwide, the incidence of new esophageal cancers is 440,000, and new deaths are 442,000 making esophageal cancer ranked ninth and sixth as the most common cancer and most frequent cancer-related cause of death, respectively. Esophageal carcinoma can be squamous cell carcinoma or adenocarcinoma, the latter increasing in frequency is North America and Europe. Obesity and reflux disease have been attributed to the cause.
Patients with esophageal cancer frequently present with dysphagia and weight loss. Once suspected, esophagography and endoscopy are diagnostic. Esophageal cancers are staged using endoscopic ultrasonography and computed tomography to assess for depth of invasion, nodal disease, and distant metastatic disease.
Early-stage esophageal cancers can be treated endoscopically avoiding the need for other modalities, while locoregionally advanced tumors require chemotherapy with radiation followed by surgery. Surgery requires esophagectomy and partial gastrectomy with replacement of the resected esophagus with a suitable tubularized replacement conduit, most commonly the stomach. Three methods of performing esophagectomy are described including the transhiatal, Ivor Lewis, and McKeown. Each technique has specific advantages and disadvantages, but preference for either technique is largely based on the surgeon preference.
Expectation, outcomes, and potential complications of esophageal surgery as well as rationale for various surgical techniques are discussed in detail.
KeywordsMinimally invasive esophagectomy Open esophagectomy Laparoscopy Esophageal cancer Minimally invasive surgery McKeown esophagectomy Ivor Lewis
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