From the Guidelines
Esophageal disconnection is not a recommended surgical technique for esophageal cancer, as the primary goal of treatment is to remove the tumor and preserve esophageal function, rather than completely separating the esophagus from the stomach. The most recent and highest quality study, 1, recommends esophagectomy as the primary surgical treatment for resectable esophageal cancer, with the goal of removing the tumor and preserving esophageal function. The surgical approach for esophageal cancer is dictated by the location and stage of the tumor, as well as the patient's overall health and preferences. Some of the acceptable operative approaches for resectable esophageal cancer include:
- Ivor Lewis esophagogastrectomy
- McKeown esophagogastrectomy
- Minimally invasive Ivor Lewis esophagogastrectomy
- Minimally invasive McKeown esophagogastrectomy
- Transhiatal esophagogastrectomy
- Robotic minimally invasive esophagogastrectomy The choice of surgical approach depends on various factors, including the location and stage of the tumor, the patient's overall health, and the surgeon's experience and preference. In terms of lymph node dissection, the study recommends that at least 15 lymph nodes should be removed for adequate nodal staging in patients undergoing esophagectomy without preoperative chemoradiation, as stated in 1. Overall, the goal of surgical treatment for esophageal cancer is to remove the tumor and preserve esophageal function, while also minimizing morbidity and mortality, and improving quality of life, as emphasized in 1 and 1.
From the Research
Esophageal Disconnect Surgical Technique
- The esophageal disconnect surgical technique is a complex procedure that requires careful preoperative assessment and planning 2.
- The technique involves the disconnection of the esophagus from the stomach, and the creation of a new connection between the esophagus and the stomach or intestine 3.
- The use of proton pump inhibitors (PPIs) has been shown to reduce the prevalence of benign anastomotic strictures after esophagectomy and gastric tube reconstruction 3.
- A study published in 2009 found that PPIs reduced the prevalence of benign anastomotic strictures from 45% to 13% 3.
- The size of the circular staple cartridge used in the procedure can also affect the prevalence of strictures, with larger cartridges reducing the risk of stricture formation 3.
Preoperative Evaluation
- Preoperative evaluation is crucial in patients undergoing esophagectomy, as it helps to identify patients with impaired pulmonary, cardiac, or nutritional function who may require special care 2.
- Tumor stage and the patient's general medical condition play equally important roles in determining operability 2.
- Preoperative tumor staging is typically done using a combination of tests, including CT, PET, and EUS 2.
Perioperative Care
- The anesthesiologist plays a key role in the perioperative care of patients undergoing esophagectomy, and should guide the patient through the preoperative, intraoperative, and postoperative phases 4.
- Protective ventilation and judicious fluid management are important components of intraoperative care, and can help to reduce the risk of complications 4.
- Postoperative care should be provided in an intensive care unit or high-dependency unit, depending on the patient's condition and the availability of local resources 4.