Thoracic Surgery and Esophagectomy

  • Melissa Morris Puskac
  • Robert A. Hetz
Reference work entry


Esophageal cancer is ranked sixth in mortality and classified as the eighth most common cause of cancer [30]. It is classified by two main histological types squamous-cell carcinoma and adenocarcinoma. Both types of malignancy differ in regard to incidence, etiology, risk factors, and population affected. Esophageal squamous-cell carcinoma has been associated with smoking, heavy alcohol use, red meat consumption, hot beverage drinking, poor oral health, low intake of fresh fruits and vegetables, and low socioeconomic status. Obesity, gastroesophageal reflux disease, and Barrett’s esophagus have been recognized as high-risk factors for adenocarcinoma of the esophagus. There are several conditions and lesions that are considered premalignant and may lead to the development of esophageal carcinoma.

Esophageal cancer is typically three to four times more common among males than in females and slightly deadlier in men than women. The most common presenting symptom in esophageal cancer is dysphagia. The majority of patients do not present with premalignant or early-stage disease but with advanced locoregional and metastatic disease. Proper histopathological diagnosis and staging are crucial in determining the adequate management of patients with esophageal cancer. There are a wide variety and combination of treatments including chemotherapy, radiation, endoscopic procedures, and surgery. Major morbidity after esophagectomy can be up to 65%. Anastomotic leak and pulmonary complications are among the most reported complications. Esophagogastric anastomotic leak accounts for 40% of postoperative fatalities after esophagectomy. The incidence is 4–17%, and the etiology is multifactorial. The 5-year survival rate for patients able to undergo resection is 47%.


Esophageal cancer Esophageal squamous-cell carcinoma Esophageal adenocarcinoma Esophagectomy Barrett’s esophagus 


  1. 1.
    Aday U, Gündeş E, Ali Çetin D, et al. Long-term evolution of squamous-cell cancer in Plummer-Vinson syndrome. Przegla̜d Gastroenterologiczny. 2017;12(3):226–8.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Ajani JA, D’Amico TA, Almhanna K, et al. Esophageal and esophagogastric junction cancers, version 1.2015: clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2015;13(2):194–227.CrossRefGoogle Scholar
  3. 3.
  4. 4.
    Blum MA, Taketa T, Sudo K, et al. Chemoradiation for esophageal cancer. Thorac Surg Clin. 2013;23:551–8.CrossRefGoogle Scholar
  5. 5.
    Colwell EM, Encarnacion CO, Rein LE, et al. Atrial fibrillation after transhiatal esophagectomy with transcervical endoscopic esophageal mobilization: one institution’s experience. J Cardiothorac Surg. 2018;13:73.CrossRefGoogle Scholar
  6. 6.
    Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol. 2013;19(25):3918–30.CrossRefGoogle Scholar
  7. 7.
    Crumley S, Schraag S. The role of local anaesthetic techniques in ERAS protocols for thoracic surgery. J Thorac Dis. 2018;10(3):1998–2004. Scholar
  8. 8.
    Cuellar SL, Carter BW, Macapiinlac HA, et al. Clinical staging of patients with early esophageal adenocarcinoma: does PDG-PET/CT have a role? J Thorac Oncol. 2014;9(8):1202–6.CrossRefGoogle Scholar
  9. 9.
    D’Amico TA. Mckeown esophagogastrectomy. J Thorac Dis. 2014;6(Suppl 3):S322–4.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Ellis A, Risk JM, Maruthappu T, et al. Tylosis with oesophageal cancer: diagnosis, management and molecular mechanisms. Orphanet J Rare Dis. 2015;10: 126.CrossRefGoogle Scholar
  11. 11.
    Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349(23):2241–52.CrossRefGoogle Scholar
  12. 12.
    Herbella FA, Dubecz A, Patti MG. Esophageal diverticula and cancer. Dis Esophagus. 2012;25(2):153–8.CrossRefGoogle Scholar
  13. 13.
    Hikage M, Kamei T, Nakano T, Abe S, Katsura K, Taniyama Y, Sakurai T, Teshima J, Ito S, Niizuma N, Okamoto H, Fukutomi T, Yamada M, Maruyama S, Ohuchi N. Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection. Surg Endosc. 2017;31(7): 2986–96.CrossRefGoogle Scholar
  14. 14.
    Hofstetter WL. Salvage esophagectomy. J Thorac Dis. 2014;6(3):341–9.Google Scholar
  15. 15.
    Kim H, Park H, Choi HS, et al. Retention esophagitis as a significant clinical predictor of progression of esophageal cancer in achalasia. Clin Endosc. 2018;51(2):161–6.CrossRefGoogle Scholar
  16. 16.
    Lv L, Hu W, Ren Y, et al. Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. Onco Targets Ther. 2016;9:6751–62.CrossRefGoogle Scholar
  17. 17.
    Ma G-W, Situ D-R, Ma Q-L, et al. Three-field vs two-field lymph node dissection for esophageal cancer: a meta-analysis. World J Gastroenterol. 2014;20(47): 18022–30.CrossRefGoogle Scholar
  18. 18.
    Miao L, Zhang Y, Hu H, Ma L, Shun Y, Xiang J, Chen H. Incidence and management of chylothorax after esophagectomy. Thorac Cancer. 2015;6(3):354–8.CrossRefGoogle Scholar
  19. 19.
    Napier KJ, Scheerer M, Misra S. Esophageal cancer: a review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol. 2014;6(5):112–20.CrossRefGoogle Scholar
  20. 20.
    Ohi M, Toiyama Y, Omura Y, et al. Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer. Surg Today. 2018; [Epub ahead of print]
  21. 21.
    Pennathur A, Zhang J, Chen H, et al. The “best operation” for esophageal cancer? Ann Thorac Surg. 2010;89(6):S2163–7.CrossRefGoogle Scholar
  22. 22.
    Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothorac Surg. 2017;6(2):119–30.CrossRefGoogle Scholar
  23. 23.
    Sakatoku Y, Fukaya M, Fujieda H, et al. Tracheoesophageal fistula after total resection of gastic conduit for gastro-aortic fistula due to gastric ulcer. Surg Case Rep. 2017;
  24. 24.
    Shridhar R, Takahashi C, Huston J, et al. Anastomotic leak and neoadjunctive chemotherapy in esophageal cancer. J Gastrointest Oncol. 2018;9(5):894–902.CrossRefGoogle Scholar
  25. 25.
    Svetanoff WJ, McGahan R, Singhal S, et al. Quality of life after esophageal resection. Patient Relat Outcome Meas. 2018;9:137–46.CrossRefGoogle Scholar
  26. 26.
    Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends – an update. Cancer Epidemiol Biomarkers Prev. 2016;25(1): 16–27.CrossRefGoogle Scholar
  27. 27.
    Van Workum F, Berkelmans GH, Klarenbeek BR, et al. McKeown or Ivor Lewis totally minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction: systematic review and meta-analysis. J Thorac Dis. 2017;9(Suppl 8):S826–33.CrossRefGoogle Scholar
  28. 28.
    Veelo DP, Geerts BF. Anaesthesia during oesophagectomy. J Thorac Dis. 2017;9(Suppl 8):S705–12.CrossRefGoogle Scholar
  29. 29.
    Yoshida N, Watanabe M, Baba Y, Iwagami S, Ishimoto T, Iwatsuki M, Sakamoto Y, Miyamoto Y, Ozaki N, Baba H. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44(3):526–32.CrossRefGoogle Scholar
  30. 30.
    Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol. 2013;19(34):5598–606.CrossRefGoogle Scholar
  31. 31.
    Zhou C, Ma G, Li X, et al. Is minimally invasive esophagectomy effective for preventing anastomotic leakages after esophagectomy for cancer? A systematic review and meta-analysis. World J Surg Oncol. 2015;13:269.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Melissa Morris Puskac
    • 1
  • Robert A. Hetz
    • 2
  1. 1.Department of Anesthesiology and Perioperative MedicineThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of Thoracic and Cardiovascular SurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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