Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Surgical Approaches to Remove the Esophagus: Vagal-Sparing
To date, no therapy has been proven superior to esophagectomy for the cure of patients with early-stage esophageal cancer. The primary goal of surgery is complete (R0) resection of the tumor to maximize the opportunity for cure and minimize the incidence of local recurrence. However, with early-stage disease and a high likelihood of long-term survival, there is an increasing focus on postesophagectomy quality of life, especially since there are endoscopic alternatives for these early lesions. This has prompted us to scale back the extent of the resection and preserve the vagal nerves to try to provide the benefits of complete resection, while minimizing some of the morbidity associated with esophagectomy in appropriate candidates.
Why a Vagal-Sparing Esophagectomy?
An esophagectomy is a major operation associated with significant perioperative and long-term physiologic alterations. During the procedure, the dissection, typically involving the mediastinum and the abdomen, leads to extensive third spacing and volume shifts in the perioperative period. These volume shifts frequently produce hemodynamic alterations and in some patients cardiopulmonary compromise. Later, the gastrointestinal alterations associated with esophagectomy and reconstruction often include dumping, diarrhea, early satiety, and gastroesophageal reflux symptoms. A laparoscopic vagal-sparing esophagectomy minimizes the dissection associated with an esophagectomy, since the esophagus is stripped out of the mediastinum without formal dissection. In addition, many of the gastrointestinal alterations associated with an esophagectomy are secondary to division of the vagus nerves, and vagal preservation minimizes dumping, diarrhea, and depending on the type of reconstruction early satiety and reflux symptoms compared with other types of esophagectomy and reconstruction. Lastly, the technique for a vagal-sparing esophagectomy with gastric pull-up allows preservation of the left gastric arterial trunk and branches to the pylorus. This improves the perfusion of the proximal portion of the graft and may reduce anastomotic leaks and stenosis.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here