ABSTRACT
It is widely recognized that a surgical procedure such as esophagectomy has lower mortality and morbidity rates when performed in high volume centers. Two major surgical approaches in case of esophagectomy for cancer have emerged in the past decades: a more limited surgical procedure with regional lymphadenectomy only (transhiatal esophagectomy-THE), and radical esophagectomy with extended lymphadenectomy (transthoracic esophagectomy-TTE). TTE with extended lymphadenectomy may offer better insight in the lymphatic dissemination of tumor cells. Dissecting more lymph nodes increases the chance of finding a tumor-positive node, which may influence pathological staging. The abdominal phase of the operation is performed through a midline supra-umbilical incision. Esophagogastrostomy is performed in the neck, and either an end-to-end, an end-to-side, or a side-to-side anastomosis is accomplished. A recent development in gastrointestinal surgery is the implementation of enhanced recovery after surgery (ERAS) programs.
