Laparoscopic and Thoracoscopic Esophagectomy with Side-Side Thoracic Anastomosis

  • Kfir Ben-DavidEmail author
  • Isaac P. Motamarry


Over the past few decades, there has been a constant increase in the number of patients diagnosed with esophageal cancer in the United States. There were 17,990 newly diagnosed patients with esophageal cancer in 2013, and 15,210 patients died from this malignancy. Although squamous cell carcinoma is the most common malignancy of the esophagus worldwide, adenocarcinoma is considerably more prevalent in the United States. Regardless of histologic character, this malignancy has a reported overall 5-year survival rate of 13–18 % since most patients have advance disease at initial presentation.

Esophageal carcinomas are generally asymptomatic, with patients typically complaining of dysphagia or odynophagia. These symptoms are generally considered late manifestations of the disease process. The esophagus lacks a serosa, which gives way to dilation, and patients are usually not symptomatic until 60 % of the circumference is obstructed. Consequently, one of the major difficulties for patients with esophageal cancer is accurate preoperative staging. Noninvasive staging modalities include computed tomography (CT) of the chest, abdomen, and pelvis and endoscopic ultrasound (EUS). EUS has become more sensitive with greater than 93 % accuracy in differentiating mucosal versus submucosal lesions. However, there are multiple limiting factors including the location, type of lesion, method and frequency of EUS probe, and the experience of the endosonographer. EUS-guided fine-needle aspiration (FNA) for lymph node staging has been compared to PET/CT in recent studies, and PET/CT has consistently predicted nodal status as well as response to neoadjuvant therapy.


Esophageal Cancer Gastric Tube Posterior Mediastinum Gastric Conduit Esophagogastric Anastomosis 
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Supplementary material

Video 12.1

Creation of a thoracoscopic side-to-side esophagogastric anastomosis (MP4 85623 kb)


  1. 1.
    Worni M, Castleberry AW, Gloor B, et al. Trends and outcomes in the use of surgery and radiation for the treatment of locally advanced esophageal cancer: a propensity score adjusted analysis of the surveillance, epidemiology, and end results registry from 1998 to 2008. Dis Esophagus. 2014;27(7):662–9.Google Scholar
  2. 2.
    Thosani N, Singh H, Kapadia A, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75:242–53.PubMedCrossRefGoogle Scholar
  3. 3.
    Cerfolio RJ, Bryant AS, Ohja B, et al. The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy. J Thorac Cardiovasc Surg. 2005;129:1232–41.PubMedCrossRefGoogle Scholar
  4. 4.
    Ben-David K, Rossidis G, Zlotecki RA, et al. Minimally invasive esophagectomy is safe and effective following neoadjuvant chemoradiation therapy. Ann Surg Oncol. 2011;18:3324–9.PubMedCrossRefGoogle Scholar
  5. 5.
    DePaula AL, Hashiba K, Ferreira EA, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc. 1995;5:1–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim T, Hochwald SN, Sarosi GA, et al. Review of minimally invasive esophagectomy and current controversies. Gastroenterol Res Pract. 2012;2012:683213.PubMedCentralPubMedGoogle Scholar
  7. 7.
    Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256:95–103.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Ben-David K, Sarosi GA, Cendan JC, et al. Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies. Surg Endosc. 2012;26:162–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Ye T, Sun Y, Zhang Y, et al. Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis. Ann Thorac Surg. 2013;96:1933–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Ben-David K, Sarosi GA, Cendan JC, et al. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg. 2010;14:1613–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Ben-David K, Kim T, Caban AM, et al. Pre-therapy laparoscopic feeding jejunostomy is safe and effective in patients undergoing minimally invasive esophagectomy for cancer. J Gastrointest Surg. 2013;17:1352–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Markar SR, Arya S, Karthikesalingam A, et al. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol. 2013;20:4274–81.PubMedCrossRefGoogle Scholar
  13. 13.
    Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.PubMedCrossRefGoogle Scholar
  14. 14.
    Biere SS, Maas KW, Bonavina L, et al. Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg. 2011;11:2.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Nguyen NT, Hinojosa MW, Smith BR, et al. Minimally invasive esophagectomy: lessons learned from 104 operations. Ann Surg. 2008;248:1081–91.PubMedCrossRefGoogle Scholar
  16. 16.
    Hochwald SN, Ben-David K. Minimally invasive esophagectomy with cervical esophagogastric anastomosis. J Gastrointest Surg. 2012;16(9):1775–81.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Florida HealthGainesvilleUSA
  2. 2.Department of General SurgeryUniversity of Florida ShandsGainesvilleUSA

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