Carcinoma of Thoracic and Cervical Esophagus: Technical Notes

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].