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Tri-incisional Esophagectomy

Philip Linden, Shawn S. Groth, David J. Sugarbaker

Key Points

  • Esophagectomy historically carries a mortality rate of 10% that has been reduced to 1% to 3% in high-volume centers with careful patient selection, meticulous technique, and intensive perioperative care.
  • Method of resection is determined by the nature and location of the disease and by the surgeon preference
  • Ivor Lewis esophagectomy affords better gastric margins for gastroesophageal junction tumors, is preferable when conduit length is marginal, and has a lower incidence of recurrent laryngeal nerve injury as compared with esophagectomy and cervical anastomosis.
  • Tri-incisional esophagectomy provides greater proximal margins, minimizes the risk of intrathoracic leak and ensures the anastomosis will be out of the radiated field for lower- and middle-third tumors. Thoracotomy is rarely required.
  • Trend toward improved survival observed with transthoracic versus transhiatal esophagectomy.
  • Pulmonary complications are the most significant sources of morbidity after any type of esophagectomy and may be minimized by the use of an epidural catheter, less invasive thoracic incisions, early ambulation, specialized care in a dedicated thoracic unit, and early cord medialization in cases of recurrent nerve injury.

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Last updated: September 4, 2024