Laparoscopic and Thoracoscopic Esophagectomy with Side-Side Thoracic Anastomosis

Abstract

Over the past few decades, there has been a constant increase in the number of patients diagnosed with esophageal cancer in the United States. There were 17,990 newly diagnosed patients with esophageal cancer in 2013, and 15,210 patients died from this malignancy. Although squamous cell carcinoma is the most common malignancy of the esophagus worldwide, adenocarcinoma is considerably more prevalent in the United States. Regardless of histologic character, this malignancy has a reported overall 5-year survival rate of 13–18 % since most patients have advance disease at initial presentation.

Esophageal carcinomas are generally asymptomatic, with patients typically complaining of dysphagia or odynophagia. These symptoms are generally considered late manifestations of the disease process. The esophagus lacks a serosa, which gives way to dilation, and patients are usually not symptomatic until 60 % of the circumference is obstructed. Consequently, one of the major difficulties for patients with esophageal cancer is accurate preoperative staging. Noninvasive staging modalities include computed tomography (CT) of the chest, abdomen, and pelvis and endoscopic ultrasound (EUS). EUS has become more sensitive with greater than 93 % accuracy in differentiating mucosal versus submucosal lesions. However, there are multiple limiting factors including the location, type of lesion, method and frequency of EUS probe, and the experience of the endosonographer. EUS-guided fine-needle aspiration (FNA) for lymph node staging has been compared to PET/CT in recent studies, and PET/CT has consistently predicted nodal status as well as response to neoadjuvant therapy.