RT Book, Section
A1 Hunter, John G.
A1 Spight, Donn H.
A1 Sandone, Corinne
A1 Fairman, Jennifer E.
SR Print(0)
ID 1162530358
T1 Transhiatal Esophagectomy
T2 Atlas of Minimally Invasive Surgical Operations
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071449052
LK accesssurgery.mhmedical.com/content.aspx?aid=1162530358
RD 2024/04/18
AB Transhiatal  esophagectomy  (THE)  is  indicated  when  two-  or  three-field  transthoracic  esophagectomy  is  unnecessary  or  when  patient  condition  suggests  that  thoracotomy  is  risky.  In  patients  with  very  early  stage  esophageal  cancer,  in  which  extended  lymph  node  dissection  is  not  necessary,  i.e.,  Barrett  esophagus  with  high  grade  dysplasia;  or  T1a  esophageal  cancer,  THE  is  indicated.  The  frequency  of  lymph  node  (LN)  metastases  with  T1b  cancer  warrants  two-  or  three-field  esophagectomy  in  the  otherwise  healthy  patient  with  esophageal  cancer.  Lower  esophageal  adenocarcinoma  or  gastroesophageal  (GE)  junction  cancer  of  more  advanced  stage  can  also  be  addressed  with  THE  in  the  patient  at  excessive  risk  of  complication  after  thoracotomy.  Advanced  cancers  of  the  mid-esophagus  should  not  be  addressed  with  THE,  as  the  midesophageal  dissection  is  essentially  blind,  and  therefore  unsafe  with  THE.  Benign  indications  for  esophagectomy  may  be  addressed  with  THE,  with  one  caveat.  The  megaesophagus  associated  with  end-stage  achalasia  is  extremely  vascular.  Attempts  to  “strip”  this  esophagus  from  its  mediastinal  bed  may  result  in  large-volume  bleeding.  Direct  transthoracic  dissection  (open  or  with  thoracoscopy)  is  advisable  in  this  setting  (Figure  1).