Esophagectomy for XXXX .

@entity1 @entity834 @entity5 @entity254 @entity338 @entity418
This review considers the esophagectomy techniques in the treatment of @entity418 and provides the guidelines for optimizing the @entity1 ' chances at cure, minimizing the risk of mediastinal enteric leak (which carries a mortality rate as high as 50%) and minimizing associated @entity338 . The 4 most commonly used routes for resection and replacement include a transhiatal, transthoracic (Ivor-Lewis), tri-incisional (right chest then simultaneous abdominal and left neck), and left chest (distal @entity5 ). Each of these techniques will be described as will the use of colon and jejunum for esophageal replacement. The healthy stomach is the preferred conduit for esophageal replacement. The stomach is well vascularized, easily reaches to the neck, and requires only a single @entity254 for re-establishing intestinal continuity. When the stomach is not available (usually because of prior surgery or disease) the choice of conduits include colon and jejunum. With respect to minimally invasive esophagectomy for @entity418 , several groups have significant experience with this and report excellent results. This is an evolving technique but holds much promise for improving the quality of life of @entity1 with @entity5 without compromising their survival. In locally advanced middle third @entity5 , thoracotomy and dissection under direct vision's desirable and improves the safety of the operation. The same may apply to @entity5 receiving neoadjuvant therapy. For @entity5 of the distal esophagus, transhiatal, tri-incisional, and Ivor-Lewis resection are probably equally as safe, and appear to result in equivalent long-term survival. An intrathoracic @entity834 is disastrous, carrying a mortality rate of up to 50%. Any surgeon who performs esophagectomy with an intrathoracic @entity254 must do so with a low incidence of leakage, certainly under 5%. Consideration should be given to a cervical placement if there are factors increasing the risk such as the use of induction therapy.
