Refers to the surgical removal of all or part of the esophagus.

This procedure is performed for patients with esophageal cancer.

Occasionally performed for benign disease such as esophageal atresia in children, achalasia, or caustic injury.

Two main types of esophagectomy: a transhiatal esophagectomy (THE) is performed on the neck and abdomen simultaneously, and a transthoracic esophagectomy (TTE) involves opening the thorax.

In most cases of esophagectomy the stomach is transplanted into the neck and the stomach takes the place originally occupied by the esophagus.

In some cases, the esophagus is replaced by another hollow structure, such as the patient’s colon.

Minimally invasive surgery is increasingly performed laparoscopically and thoracoscopically.

Minimally invasive esophagectomy with video assisting thoracoscopy surgery can sometimes be performed
An abdominal incision is required to make the stomach into a conduit that connects the remains of the healthy esophagus to the rest of the gastrointestinal tract.
The abdominal surgery can be done at laparotomy or with laparoscopic or a robotic surgery.
The remainder of the esophagus and stomach can be reconnected in the chest to establish continuity for swallowing and eating.
If the esophageal cancer is high up in the esophagus, a third incision in the neck is needed to ensure the entire tumor is removed and the connection is performed in the neck instead of the chest.

Surgery takes between 4 and 8 hours to perform.

Average mortality rate is around 10%, but when the procedure is performed in major cancer centers rates are under 5%.

Major complications occur in 10-20% of cases.

Operative mortality 3-4.2% in specialized cancer centers and 12.2-13.3% in hospitals performing fewer esophagectomies.

About 30-50% of patients develop complications including: pneumonia, atelectasis, arrhythmias, myocardial infarction, heart failure, wound infections and anastomotic leaks.

Minimally invasive esophagectomy both thoroscopic and laparoscopic are associated with lower incidence of pulmonary complications than open esophagectomy.

Hybrid minimally invasive esophagectomy combines a laparoscopic abdominal phase with an open thoracotomy and may have fewer pulmonary complications, and laparoscopic tumor dissection limiting potential tumor spillage and easier reducibility of the technique: it does not compromise overall and disease free survival over a period of three years.

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