Thoracic Surgery and Esophagectomy
Esophageal cancer is ranked sixth in mortality and classified as the eighth most common cause of cancer . 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%.
KeywordsEsophageal cancer Esophageal squamous-cell carcinoma Esophageal adenocarcinoma Esophagectomy Barrett’s esophagus
- 3.American Cancer Society (2018) Cancer facts & figures 2018. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html
- 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.Hofstetter WL. Salvage esophagectomy. J Thorac Dis. 2014;6(3):341–9.Google Scholar
- 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; https://doi.org/10.1007/s00595-018-1721-0. [Epub ahead of print]
- 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; https://doi.org/10.1186/s400792-017-0371-6.