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Arch Hellen Med, 27(4), July-August 2010, 635-639


The evolution of techniques and prospects in esophagectomy

1First Department of Surgery "Αsklepieiο Voulas" General Hospital, Athens,
2Second Department of Propedeutic Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

Resection of the esophagus, an organ which crosses three anatomical regions, is traditionally regarded as a complex surgical procedure carrying a high operative risk. Indications for esophagectomy include carcinoma, severe dysplasia arising from columnar metaplasia (known as "Barrett's esophagus") and benign esophageal conditions such as corrosive injuries and megaesophagus due to end-stage achalasia. Transthoracic esophagectomy was started in the early 20th century and it has evolved into the Ivor Lewis technique, which is still in wide use. In the case of esophageal cancer, radical resection of the tumor and mediastinal lymph nodes can be achieved through the transthoracic approach, but this is associated with increased respiratory morbidity. Since the decade of the 1970s the technique of transhiatal esophagectomy has become established, mainly because of its lower respiratory morbidity, although it is unclear whether in the case of esophageal cancer this method can achieve survival rates equal to those of the transthoracic approach. Over recent years novel methods of minimally invasive esophagectomy have evolved. Resection of the esophagus using thoracoscopic and laparoscopic techniques achieves reduction in postoperative morbidity and faster recovery, and it can be equally as radical as the thoracotomy approach. Endoscopic esophagectomy, however, requires a long learning curve and advanced skills on the part of the surgeons, who also need be very experienced in the open techniques. Esophageal surgeons should be aware of their limitations, and should be experienced in patient selection and apply the most appropriate technique in each case.

Key words: Esophagectomy, Laparoscopy, Thoracoscopy, Thoracotomy.

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