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Esophagus Resection

General

During a resection of the esophagus, the portion aboral part of the esophagus with the tumour is resected and the stomach is pulled up into the thorax, if necessary all the way up into the collum, and is anastomosed with the remaining esophagus.

Access can be:

  • transthoracic by creating an opening between the ribs. This provides the best access in the thorax and the easiest lymph node dissection. 
  • transhiatal by operating in the thorax via an opening in the diaphragm and finally anastomosing to the throat. This technique may caus less cardiopulmonary complications.

Cervical esophagus:

  • from the cricoid cartilage to thorax opening (about 15–25 cm from the teeth).
  • regional lymph nodes: cervical, peri-esophageal, internal jugular, scalene, and supraclavicular

Thoracic esophagus:

  • upper: from the opening of the thorax to the tracheal bifurcation (approx. 25–35 cm from the teeth)
  • lower: the distal half between the tracheal bifurcation and cardia (approx. 35–45 cm from the teeth) regional lymph nodes: upper and lower peri-esophageal, subcarinal, mediastinal, and perigastric

The impact of an extensive lymph node dissection is uncertain. In Japan, in the last few decades, it has been emphasized that a lymph node dissection must be performed in the thorax, abdomen, and neck. This has achieved a 40-50% 5 year survival. Western studies have not been able to obtain similar results, therefore lymph node dissections have not been performed to a similar extent. 

Indications

  • Transthoracic access: tumor in all parts
  • Transhiatal access: tumor in upper or lower part of esophagus

Contraindications

  • Metastases to the lungs, liver, or other metastases
  • Infiltration in the lungs, trachea, pericardia, aorta
  • Spreading to supraclavicular lymph nodes
  • Heart/lung disease to a relative severe degree

At the time of diagnosis, over half of the patients will meet one or more criteria for inoperability, therefore only palliative treatment is offered.

Goal

  • Cure

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