Esophagectomy

When esophagectomy is the complete surgical removal of the esophagus (esophagus). The partial surgical removal of the esophagus is known as esophagectomy .

Indications

Both benign (motility disorders = movement disorders of the esophagus, e.g. achalasia ) and malignant diseases ( esophageal carcinoma ) can make surgical removal of the esophagus necessary. If it is an intervention for carcinoma, it is also called a radical esophagectomy. This involves removing the esophagus and the adjacent lymph nodes ( lymphadenectomy ).

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A distinction is made between different forms of this procedure. On the one hand, the procedure can be carried out by opening the chest cavity ( thoracotomy ) (so-called transthoracic esophagectomy). On the other hand, the esophagus can be bluntly removed from the abdomen ( laparotomy ) through the diaphragm (“stripping”, transhiatal esophagectomy).

The first (intrathoracic) esophagectomy was performed in 1915 by the surgeon Thorek in New York.

Reconstruction / restoration of the dining passage

To restore the passage of food after esophagectomy, the stomach can be shaped into a replacement esophagus and connected to the upper esophageal stump (so-called gastric pull-up ). Another possibility is the interposition of a part of the large intestine (so-called interposition of the large intestine, colon interposition ).

Risks and Complications

The esophagectomy is one of the larger visceral surgical operations and is associated with a multitude of specific complication possibilities. Here are the most important:

• Bleeding: The topographical proximity to the large vessels and the difficult access carry the risk of severe intra- and postoperative bleeding.
• Anastomotic leakage: The "opening" of the seam connection between the pulled up stomach or large intestine can lead to serious, life-threatening infections. These are by collarer (at the neck lying) anastomosis still more manageable than with intrathoracic anastomosis in esophageal partial resection. In this case, life-threatening mediastinitis (inflammation of the middle skin) threatens .
• Anastomotic stricture: Scarred shrinkage in the anastomotic area endangers the patency of the anastomosis and prevents oral nutrition.
• Aspiration pneumonia : The lack of sphincter muscle function can lead to uncontrollable reflux of the ingested food and, if aspirated, to dangerous pneumonia (pneumonia).
• Peritonitis : Insufficiency of the lower anastomosis with colonic interposition can lead to life-threatening peritonitis.

Sample dependency of the results

The dependence of the results of the esophagectomy on the number of cases (number of procedures performed in the hospital per year) has been proven. In hospitals with fewer than two interventions per year, around 18% of patients die, whereas in large centers the mortality rate can be less than 5%.

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• JR Siewert: Surgery. 7th edition. Springer-Verlag, 2001, ISBN 3-540-67409-8 .
• JR Siewert, H. Bartels, HJ Stein: Abdomino-right-thoracic esophagectomy with intrathoracic anastomosis in Barrett's cancer. In: surgeon. 2005 Jun; 76 (6), pp. 588-594. PMID 15875146

Individual evidence

1. ↑ Ernst Kern : Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 275.
2. ↑ JD Birkmeyer et al .: Hospital volume and surgical mortality in the United States. In: N Engl J Med. 2002 Apr 11; 346 (15), pp. 1128-1137. PMID 11948273
3. ^ JD Birkmeyer et al .: Surgeon volume and operative mortality in the United States. In: N Engl J Med. 2003 Nov 27; 349 (22), pp. 2117-2127. PMID 14645640

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