Carcinoma of Thoracic and Cervical Esophagus: Technical Notes

  • Giovanni de Manzoni
  • Simone Giacopuzzi
  • Gerardo Mangiante
Part of the Updates in Surgery book series (UPDATESSURG)


Historically, surgeons have controversially discussed the merits of one surgical approach over another. According to Orringer, for example, every patient in need of an esophagectomy for malignant disease is a potential candidate for trans-hiatal esophagectomy (THE). Other surgeons claim the superiority of the trans-thoracic approach (TTE), performed in two or three phases depending on whether the tumor is above or below the carina. TTE has the advantage of a more radical resection and lymphadenectomy. The majority of the published trials report a higher incidence of anastomotic leakage and vocal cord paralysis after THE, while TTE more often results in pulmonary complications and greater peri-operative blood loss [1, 2]. The most recent Dutch randomized trial, dealing only with adenocarcinoma and already discussed in previous chapters, showed a higher complication rate in the TTE group while no difference was reported in mortality; additionally, a survival advantage was noted for patients with tumors located in the distal esophagus [3]. In a recent international survey, 52% of the surgeons were found to prefer TTE and 26% THE [4].


Gastric Tube Circular Stapler Thoracic Esophagus Lower Esophagus Cervical Esophagus 
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  1. 1.
    Battocchia A, Laterza E (2002) Le malattie del’esofago. Diagnosi e Terapia. Piccin Editore, PadovaGoogle Scholar
  2. 2.
    Orringer MB, Marschall B, Chang AC et al (2007) Two thousand transhiatal esophagectomies: changing trend, lessons learned. Ann Surg 246: 363–372PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Hulscher JB, van Sandick JW, De Boer AG et al (2002). Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. New Engl J Med 347:1662–1669PubMedCrossRefGoogle Scholar
  4. 4.
    Boone J, Livestro DP, Elias SG et al (2009) International Survey on esophageal cancer: part I surgical techniques. Dis Esophagus 22:195–202PubMedCrossRefGoogle Scholar
  5. 5.
    Grillo HC, Mathisen DJ (1990) Cervical Exenteration. Ann Thor Surg 49:401–408CrossRefGoogle Scholar
  6. 6.
    Cordiano C, Stipa V, Tendella E (1982) Chirurgia dell’Esofago e dell’ipofaringe Trattato di tecnica chirurgica (a cura di C. Cordiano) Volume V/2. Piccin Editore, PadovaGoogle Scholar
  7. 7.
    Cordiano C, Nardi G (1989) Color Atlas of Gastrointestinal Surgery. Piccin Editore, Padova.Google Scholar
  8. 8.
    Chasseray VM, Kiroff GK, Buard JL et al (1989) Cervical or thoracic anastomosis for esophagectomy for carcinoma. Surg Gynecol Obstet 169:55–62PubMedGoogle Scholar
  9. 9.
    Ribet M, Debrueres B, Lecomte HM (1992) Resection for advanced cancer of the thoracic esophagus: cervical or thoracic anastomosis? late results of a prospective randomised study. J Thorac Cardiovasc Surg 103:784–789PubMedGoogle Scholar
  10. 10.
    Walther B, Johansson J, Johnson F et al (2003) Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapler intrathoracic anastomosis. Ann Surg 238: 803–812PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Okuyama M, Motoyama S, Suzuki H et al (2007) Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosisfor esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled trial. Surgery Today 37:947–952PubMedCrossRefGoogle Scholar
  12. 12.
    Biere SSAY, Maas KW, Cuesta MA, van der Pet (2011) Cervical or thoracic anastomosis after esophagectomy for cancer: a systematic review and meta-analysis. Dig Surg 28: 29–35PubMedCrossRefGoogle Scholar
  13. 13.
    Laterza E, de Manzoni G, Veraldi GF et al (1999) Manual compared with mechanical cervical oesophagogastric anastomosis: a randomised trial. Eur J Surg 165:1051–1054PubMedCrossRefGoogle Scholar
  14. 14.
    Urschel JD, Blewett CJ, Bennett WF et al (2001) Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Dis Esophagus 14:12–217CrossRefGoogle Scholar
  15. 15.
    Kasai M, Abols SI, Makino K et al (1965) Reconstruction of the cervical esophagus by a pedicled jejunal graft. Surg Gynecol Obstet 121:102–106PubMedGoogle Scholar
  16. 16.
    Li HH, Zhang QZ, Xu L, Hu JW (2008) Clinical outcome of esophageal cancer after distal gastrectomy: a prospective study. Int J Surg 6:129–135PubMedCrossRefGoogle Scholar
  17. 17.
    Urschel JD, Blewett CJ, Young JE et al (2002) Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials. Dig Surg 19:160–164PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Giovanni de Manzoni
    • 1
  • Simone Giacopuzzi
  • Gerardo Mangiante
  1. 1.Dept. of Surgery, Upper G.I. Surgery DivisionUniversity of VeronaVeronaItaly

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