Esophagectomy

Resection of the esophagus and proximal stomach followed by reconstruction to reestablish gastrointestinal continuity with a gastric pull-up or other conduit is a complex, multi-step operation that requires considerable attention to detail. An understanding of the surgical anatomy of the esophagus as it courses through the neck, chest, and abdomen is critical, as well as knowledge of the functional changes that occur with this radical change in anatomy. Esophagectomy is still associated with significant risk of morbidity and mortality, with postoperative morbidity rates of 30–60% reported in large case series from high volume centers. A technically sound operation, as well as attentive perioperative care and patient education are crucial to minimize the risk of complications. In this chapter we present indications for esophageal resection, standards in pre-operative evaluation and describe common surgical techniques and specific complications.