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Esophageal Anatomy

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Esophageal Cancer

Abstract

The esophagus has a peculiar anatomy: (a) it is surrounded by important organs and structures, (b) it crosses three cavities: neck, thorax and abdomen, (c) its lymphatic distribution is abundant and erratic, (d) the organs and structures of the mediastinum frequently present anatomic variations, and (e) the classic anatomic description is different from clinical presentation. In addition, minimally invasive surgery also brought a restricted but magnified view of the esophagus, and available imaging technology forces the understanding of sectional and regional anatomy. For all these reasons, the knowledge of the surgical anatomy of the esophagus is essential for surgeons before performing an esophagectomy. This chapter reviews the surgical anatomy of the esophagus and neighbor structures of interest to perform an esophagectomy.

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References

  1. Oezcelik A, DeMeester SR. General anatomy of the esophagus. Thorac Surg Clin. 2011;21(2):289–97. https://doi.org/10.1016/j.thorsurg.2011.01.003.

    Article  PubMed  Google Scholar 

  2. Rice TW, Bronner MP. The esophageal wall. Thorac Surg Clin. 2011;21(2):299–305. https://doi.org/10.1016/j.thorsurg.2011.01.005.

    Article  PubMed  Google Scholar 

  3. Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14(1):1–36. https://doi.org/10.1007/s10388-016-0551-7.

    Article  Google Scholar 

  4. Shimamura Y, Ikeya T, Marcon N, Mosko JD. Endoscopic diagnosis and treatment of early esophageal squamous neoplasia. World J Gastrointest Endosc. 2017;9(9):438–47. https://doi.org/10.4253/wjge.v9.i9.438.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rizvi QU, Balachandran A, Koay D, et al. Endoscopic management of early esophagogastric cancer. Surg Oncol Clin. 2017;26(2):179–91. https://doi.org/10.1016/j.soc.2016.10.007.

    Article  Google Scholar 

  6. Patti MG, Gantert W, Way LW. Surgery of the esophagus. Anatomy and physiology. Surg Clin North Am. 1997;77(5):959–70. Review. PMID: 9347826.

    Article  CAS  PubMed  Google Scholar 

  7. Gray H. Lymphatic drainage of thorax. In: Williams PL, editor. Gray’s anatomy. 38th ed. New York: Churchill Livingstone; 1995. p. 1624–6.

    Google Scholar 

  8. Yasuda T, Yano M, Miyata H, et al. Evaluation of dysphagia and diminished airway protection after three-field esophagectomy and a remedy. World J Surg. 2013;37:416. https://doi.org/10.1007/s00268-012-1822-7.

    Article  PubMed  Google Scholar 

  9. Orringer MB. Transhiatal esophagectomy without thoracotomy. Oper Tech Thorac Cardiovasc Surg. 2005;10(1):63–83. https://doi.org/10.1053/j.optechstcvs.2005.03.001.

    Article  Google Scholar 

  10. Takassi GF, Herbella FAM, Patti MG. Anatomic variations in the surgical anatomy of the thoracic esophagus and its surrounding structures. Arq Bras Cir Dig. 2013;26(2):101–6. https://doi.org/10.1590/S0102-67202013000200006.

    Article  PubMed  Google Scholar 

  11. Yajima S, Oshima Y, Shimada H. Neck dissection for thoracic esophageal squamous cell carcinoma. Int J Surg Oncol. 2012;2012:750456. https://doi.org/10.1155/2012/750456.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Markar SR, Wiggins T, Antonowicz S, et al. Minimally invasive esophagectomy: lateral decubitus vs. prone positioning; systematic review and pooled analysis. Surg Oncol. 2015;24(3):212–9. https://doi.org/10.1016/j.suronc.2015.06.001.

    Article  PubMed  Google Scholar 

  13. Weijs TJ, Ruurda JP, Luyer MDP, et al. New insights into the surgical anatomy of the esophagus. J Thorac Dis. 2017;9(Suppl 8):S675–80. https://doi.org/10.21037/jtd.2017.03.172.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Herbella FA, Regatieri CV, Moreno DG, et al. Vagal integrity in vagal-sparing esophagectomy: a cadaveric study. Dis Esophagus. 2006;19(5):406–9. https://doi.org/10.1111/j.1442-2050.2006.00595.x.

    Article  PubMed  CAS  Google Scholar 

  15. Weijs TJ, Ruurda JP, Luyer MD, et al. Preserving the pulmonary vagus nerve branches during thoracoscopic esophagectomy. Surg Endosc. 2016;30:3816–22. https://doi.org/10.1007/s00464-015-4683-y.

    Article  PubMed  Google Scholar 

  16. Altorki N, Skinner D. Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg. 2001;234(5):581–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Boone J, Schipper MEI, Bleys RLAW, et al. The effect of azygos vein preservation on mediastinal lymph node harvesting in thoracic esophagolymphadenectomy. Dis Esophagus. 2007;29(3):226–9. https://doi.org/10.1111/j.1442-2050.2007.00760.x.

    Article  Google Scholar 

  18. Gelpke H, Grieder F, Decurtins M, Cadosch D. Recurrent laryngeal nerve monitoring during esophagectomy and mediastinal lymph node dissection. World J Surg. 2010;34:2379–82. https://doi.org/10.1007/s00268-010-0692-0.

    Article  PubMed  Google Scholar 

  19. Wang J, Li J, Liu G, Deslauriers J. Nerves of the mediastinum. Thorac Surg Clin. 2011;21:239–49. https://doi.org/10.1016/j.thorsurg.2011.01.006.

    Article  PubMed  Google Scholar 

  20. Hematti H, Mehran RJ. Anatomy of the thoracic duct. Thorac Surg Clin. 2011;21(2):229–38. (ix). https://doi.org/10.1016/j.thorsurg.2011.01.002.

    Article  PubMed  Google Scholar 

  21. Crucitti P, Mangiameli G, Petitti T, et al. Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50(6):1019–24. https://doi.org/10.1093/ejcts/ezw125.

    Article  PubMed  Google Scholar 

  22. Tong D, Law S. Extended lymphadenectomy in esophageal cancer is crucial. World J Surg. 2013;37:1751–6. https://doi.org/10.1007/s00268-013-2068-8.

    Article  PubMed  Google Scholar 

  23. Herbella FA, Del Grande JC, Colleoni R, Japanese Society for Diseases of the Esophagus. Anatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese Society for Diseases of the Esophagus. Surg Today. 2003;33:249–53. https://doi.org/10.1007/s005950300056.

    Article  PubMed  Google Scholar 

  24. Bello B, Herbella FA, Allaix ME, Patti MG. Impact of minimally invasive surgery on the treatment of benign esophageal disorders. World J Gastroenterol. 2012;18(46):6764–70. https://doi.org/10.3748/wjg.v18.i46.6764.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ma G-W, Situ D-R, Ma Q-L, et al. Three-field vs two-field lymph node dissection for esophageal cancer: a meta-analysis. World J Gastroenterol. 2014;20(47):18022–30. https://doi.org/10.3748/wjg.v20.i47.18022.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Giacopuzzi S, Bencivenga M, Cipollari C, et al. Lymphadenectomy: how to do it? Transl Gastroenterol Hepatol. 2017;2:28. https://doi.org/10.21037/tgh.2017.03.09.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Irino T, Tsekrekos A, Coppola A, et al. Long-term functional outcomes after replacement of the esophagus with gastric, colonic, or jejunal conduits: a systematic literature review. Dis Esophagus. 2017;30(12):1–11. https://doi.org/10.1093/dote/dox083.

    Article  PubMed  CAS  Google Scholar 

  28. Marks JL, Hofstetter WL. Esophageal reconstruction with alternative conduits. Surg Clin North Am. 2012;92:1287–97. https://doi.org/10.1016/j.suc.2012.07.006.

    Article  PubMed  Google Scholar 

  29. Liebermann-Meffert DM, Meier R, Siewert JR. Vascular anatomy of the gastric tube used for esophageal reconstruction. Ann Thorac Surg. 1992;54:1110–5.

    Article  CAS  PubMed  Google Scholar 

  30. Peters JH, Kronson JW, Katz M, DeMeester TR. Arterial anatomic considerations in colon interposition for esophageal replacement. Arch Surg. 1995;130(8):858–62. discussion 862–3.

    Article  CAS  PubMed  Google Scholar 

  31. Hamai Y, Hihara J, Emi M, Aoki Y, Okada M. Esophageal reconstruction using the terminal ileum and right colon in esophageal cancer surgery. Surg Today. 2012;42:342–50. https://doi.org/10.1007/s00595-011-0103-7.

    Article  PubMed  Google Scholar 

  32. Fürst H, Hartl WH, Löhe F, Schildberg FW. Colon interposition for esophageal replacement: an alternative technique based on the use of the right colon. Ann Surg. 2000;231(2):173–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ventemiglia R, Khalil KG, Frazier OH, Mountain CF. The role of preoperative mesenteric arteriography in colon interposition. J Thorac Cardiovasc Surg. 1977;74:98–104.

    PubMed  CAS  Google Scholar 

  34. Rice TW. Right colon interposition for esophageal replacement. Oper Tech Thorac Cardiovasc Surg. 1999;4(3):210–21. https://doi.org/10.1016/S1522-2942(07)70118-6.

    Article  Google Scholar 

  35. Predescu D, Popa B, Gheorghe M, et al. The vascularization pattern of the colon and surgical decision in esophageal reconstruction with colon. A selective SMA and IMA arteriographic study. Chirurgia (Bucur). 2013;108:161–71.

    CAS  Google Scholar 

  36. Fisher RA, Griffiths EA, Evison F, et al. A national audit of colonic interposition for esophageal replacement. Dis Esophagus. 2017;30(5):1–10. https://doi.org/10.1093/dote/dow003.

    Article  PubMed  CAS  Google Scholar 

  37. Chen H, Lu JJ, Zhou J, Zhou X, Luo X, Liu Q, Tam J. Anterior versus posterior routes of reconstruction after esophagectomy: a comparative anatomic study. Ann Thorac Surg. 2009;87:400–4. https://doi.org/10.1016/j.athoracsur.2008.11.016.

    Article  PubMed  Google Scholar 

  38. Hu H, Ye T, Tan D, et al. Is anterior mediastinum route a shorter choice for esophageal reconstruction? A comparative anatomic study. Eur J Cardiothorac Surg. 2011;40:1466–9. https://doi.org/10.1016/j.ejcts.2011.03.038.

    Article  PubMed  Google Scholar 

  39. Coral RP, Constant-Neto M, Silva IS, et al. Comparative anatomical study of the anterior and posterior mediastinum as access routes after esophagectomy. Dis Esophagus. 2003;16(3):236–8.

    Article  CAS  PubMed  Google Scholar 

  40. Cooke DT, Calhoun RF. Distance alone does not define the value of the posterior mediastinal route for esophageal reconstruction. Ann Thorac Surg. 2009;88(4):1390. https://doi.org/10.1016/j.athoracsur.2009.03.036.

    Article  PubMed  Google Scholar 

  41. Fukuda M, Hirata K, Natori H. Endoscopic ultrasonography of the esophagus. World J Surg. 2000;24:216–26.

    Article  CAS  PubMed  Google Scholar 

  42. Dietrich CF, Liesen M, Buhl R, et al. Detection of normal mediastinal lymph nodes by ultrasonography. Acta Radiol. 1997;38:965–9.

    Article  CAS  PubMed  Google Scholar 

  43. Ba-Ssalamah A, Zacherl J, Noebauer-Huhmann IM, et al. Dedicated multi-detector CT of the esophagus: spectrum of diseases. Abdom Imaging. 2009;34:3–18. https://doi.org/10.1007/s00261-007-9290-5.

    Article  PubMed  Google Scholar 

  44. Quint LE, Glazer GM, Orringer MB, et al. Mediastinal lymph node detection and sizing at CT and autopsy. AJR Am J Roentgenol. 1986;147:469–72. https://doi.org/10.2214/ajr.147.3.469.

    Article  PubMed  CAS  Google Scholar 

  45. Riddell AM, Davies DC, Allum WH, et al. High-resolution MRI in evaluation of the surgical anatomy of the esophagus and posterior mediastinum. AJR Am J Roentgenol. 2007;188:W37–43. https://doi.org/10.2214/AJR.05.1795.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Fernando A. M. Herbella .

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Menezes, M.A., Sato, R.O., Schlottmann, F., Herbella, F.A.M. (2018). Esophageal Anatomy. In: Schlottmann, F., Molena, D., Patti, M. (eds) Esophageal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-91830-3_1

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  • DOI: https://doi.org/10.1007/978-3-319-91830-3_1

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