ABSTRACT
A two-stage resection with a two-field lymphadenectomy is the procedure of choice for lower and middle third esophageal cancers, and types I and II junctional cancers. Prophylactic antibiotics are administered. A pneumatic calf compression device is used to reduce to the risk of venous thromboembolism. The stomach is the standard conduit used to replace the resected esophagus. The initial dissection releases any adhesions from the gastrosplenic ligament to the lower pole of the spleen, as this reduces the risk of an inadvertent traction injury. A pyloroplasty is routinely performed by the authors to improve gastric emptying and reduce the risk of aspiration. A posterolateral incision following the line of the ribs is made, skirting below the tip of the scapula, aimed toward the nipple, and terminating at the anterior axillary line. Diathermy and a bipolar electrosurgical tissue-sealing device are used to dissect through the tissues and divide the latissimus dorsi and serratus anterior muscles.
