Surgical Approaches to Remove the Esophagus: Open

Abstract Surgical resection remains the cornerstone of therapy for patients with resectable cancer of the esophagus in the absence of systemic metastases. Surgery, most of the time combined with neoadjuvant therapy in current practice, offers the highest likelihood of cure for patients with locoregional disease. To obtain the best results, the management of esophageal cancer should be individualized and based on a combination of factors including the physiologic status of the patient, tumor type and location, and stage of disease. In this chapter, we describe the different open surgical approaches to remove the esophagus in patients with esophageal cancer. Although minimally invasive techniques are increasingly applied, the benefits of fully minimally invasive esophagectomy have not yet been proven unequivocally, and an open or hybrid esophagectomy remains the standard procedure to remove the esophagus in many leading high-volume centers worldwide. At present, the only strong available evidence comes from preliminary results of the French randomized MIRO trial comparing hybrid transthoracic esophagectomy (TTE, laparoscopic gastric mobilization , and open thoracotomy) with fully open TTE. These results suggest that hybrid TTE significantly reduces postoperative complications compared with open TTE (odds ratio for postoperative morbidity, 0.31; 95% confidence interval, 0.18 to 0.55; P = .0001; percentage of pulmonary complications: 17.7% vs. 30.1% vs. P = .037). The open thoracic part of hybrid TTE is similar to that of fully open TTE (this chapter), whereas the laparoscopic (abdominal) part is described in detail in another chapter.