Minimally Invasive Esophagectomy



Minimally Invasive Esophagectomy


Benjamin We

Robert J. Cerfolio

Mary T. Hawn





PATIENT HISTORY AND PHYSICAL FINDINGS



  • Patients with esophageal malignancy present with progressive dysphagia and weight loss. The incidence is higher in men and in smokers. Patients often have a long-standing history of gastroesophageal reflux symptoms. The physical examination is usually unremarkable.


IMAGING AND OTHER DIAGNOSTIC STUDIES



  • All patients with dysphagia should be evaluated with an upper endoscopy and biopsy of suspicious lesions. Patients with biopsy-proven carcinoma are staged to determine treatment. The staging process includes computed tomography (CT) of the chest and abdomen, an integrated positron emission tomography (PET)/CT, and endoscopic ultrasound. Patients with T3 or N1 disease are treated with neoadjuvant chemoradiation and restaged prior to resection.


SURGICAL MANAGEMENT


Preoperative Planning



  • If the patient is unable to maintain adequate nourishment during neoadjuvant therapy or is malnourished and too weak for resection, we place a jejunostomy tube (J-tube), preferably with a laparoscopic approach. This allows for staging and the ability to rule out metastatic disease. A percutaneous endoscopic gastrostomy tube should be avoided in any patient that is being considered for esophageal resection. Additionally, having the J-tube placed up front minimizes the abdominal portion of the esophageal resection procedure.


Positioning for the Abdominal Portion



  • The patient is positioned in the supine position with both arms tucked and a Foley catheter in place. We do not routinely use an arterial line or a central line. A nasogastric tube (NGT) is routinely placed. If one is placed, care must be taken to pull it far back into the esophagus as well as to remove all esophageal temperature probes or other devices prior to stapling the stomach. If body habitus or other concerns prevent arm tucking, it is not a necessity.

Jul 24, 2016 | Posted by in GENERAL SURGERY | Comments Off on Minimally Invasive Esophagectomy

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