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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Resection of primary esophageal neoplasm and locoregional lymph nodes
- 2-field (mediastinal and upper abdominal) lymphadenectomy
- Most commonly performed
- Three-field (cervical, mediastinal, and upper abdominal) lymphadenectomy
- Possible survival benefit for patients with squamous cell carcinoma
- 2-field (mediastinal and upper abdominal) lymphadenectomy
- Resection of primary esophageal neoplasm and locoregional lymph nodes
Types of Esophagectomy
- Ivor-Lewis
- Most common technique for resection of mid and lower esophageal neoplasms
- Open surgery, minimally invasive or robotic procedures
- Upper midline abdominal incision
- Stomach mobilization; creation of gastric tube
- Lymph node resection along celiac trunk, splenic, and common hepatic arteries
- ± pyloromyotomy or pyloroplasty to prevent postvagotomy gastric outlet obstruction
- Posterolateral right thoracotomy
- Resection of esophagus and mediastinal lymph nodes
- Gastric tube pulled into thorax through esophageal hiatus
- Anastomosis in upper thorax
- Risk of mediastinitis with anastomotic leak
- Most common technique for resection of mid and lower esophageal neoplasms
- Transhiatal
- Curative or palliative resection of esophageal malignancies or benign conditions; patients who cannot tolerate thoracotomy
- Neck and abdominal incisions
- Blind dissection of intrathoracic esophagus
- Potentially less complete removal of intrathoracic lymph nodes
- Anastomosis in left lower neck
- Easier access of potential anastomotic leak
- Removes risk of mediastinitis as result of leak
- McKeown
- Treatment of upper esophageal neoplasms
- Similar to Ivor-Lewis with addition of cervical incision for lymph node dissection and lower cervical anastomosis
- Other approaches, such as left thoracotomy, are less commonly performed
- Ivor-Lewis
Conduit for Reconstruction
- Stomach
- Most common
- Resection of gastric lesser curve and cardia, and closure with staple line to form gastric tube
- Gastric conduit most commonly placed in prevertebral or paravertebral space
- Less commonly in retrosternal space
- Colon or jejunum used if stomach diseased or prior gastric conduit failed
- Stomach
IMAGING
Radiographic Findings
Fluoroscopic Findings
CT Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Natural History & Prognosis
Indications for Esophagectomy
Risk Factors for Immediate Pulmonary Complications
Post-Esophagectomy Complications
Selected References
- Benjamin G et al: Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature. Hernia. ePub, 2015
- van Rossum PS et al: Calcification of arteries supplying the gastric tube: a new risk factor for anastomotic leakage after esophageal surgery. Radiology. 274(1):124-32, 2015
- Christensen JD et al: Imaging of complications of thoracic and cardiovascular surgery. Radiol Clin North Am. 52(5):929-59, 2014
- Sonavane S et al: Expected and unexpected imaging features after oesophageal cancer treatment. Clin Radiol. 69(8):e358-66, 2014
- Devenney-Cakir B et al: Complications of esophageal surgery: role of imaging in diagnosis and treatments. Curr Probl Diagn Radiol. 40(1):15-28, 2011
- Upponi S et al: Radiological detection of post-oesophagectomy anastomotic leak - a comparison between multidetector CT and fluoroscopy. Br J Radiol. 81(967):545-8, 2008
- Kim TJ et al: Postoperative imaging of esophageal cancer: what chest radiologists need to know. Radiographics. 27(2):409-29, 2007
- Upponi S et al: Imaging following surgery for oesophageal cancer. Clin Radiol. 62(8):724-31, 2007
- Kim SH et al: Esophageal resection: indications, techniques, and radiologic assessment. Radiographics. 21(5):1119-37; discussion 1138-40, 2001
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Definitions
- Resection of primary esophageal neoplasm and locoregional lymph nodes
- 2-field (mediastinal and upper abdominal) lymphadenectomy
- Most commonly performed
- Three-field (cervical, mediastinal, and upper abdominal) lymphadenectomy
- Possible survival benefit for patients with squamous cell carcinoma
- 2-field (mediastinal and upper abdominal) lymphadenectomy
- Resection of primary esophageal neoplasm and locoregional lymph nodes
Types of Esophagectomy
- Ivor-Lewis
- Most common technique for resection of mid and lower esophageal neoplasms
- Open surgery, minimally invasive or robotic procedures
- Upper midline abdominal incision
- Stomach mobilization; creation of gastric tube
- Lymph node resection along celiac trunk, splenic, and common hepatic arteries
- ± pyloromyotomy or pyloroplasty to prevent postvagotomy gastric outlet obstruction
- Posterolateral right thoracotomy
- Resection of esophagus and mediastinal lymph nodes
- Gastric tube pulled into thorax through esophageal hiatus
- Anastomosis in upper thorax
- Risk of mediastinitis with anastomotic leak
- Most common technique for resection of mid and lower esophageal neoplasms
- Transhiatal
- Curative or palliative resection of esophageal malignancies or benign conditions; patients who cannot tolerate thoracotomy
- Neck and abdominal incisions
- Blind dissection of intrathoracic esophagus
- Potentially less complete removal of intrathoracic lymph nodes
- Anastomosis in left lower neck
- Easier access of potential anastomotic leak
- Removes risk of mediastinitis as result of leak
- McKeown
- Treatment of upper esophageal neoplasms
- Similar to Ivor-Lewis with addition of cervical incision for lymph node dissection and lower cervical anastomosis
- Other approaches, such as left thoracotomy, are less commonly performed
- Ivor-Lewis
Conduit for Reconstruction
- Stomach
- Most common
- Resection of gastric lesser curve and cardia, and closure with staple line to form gastric tube
- Gastric conduit most commonly placed in prevertebral or paravertebral space
- Less commonly in retrosternal space
- Colon or jejunum used if stomach diseased or prior gastric conduit failed
- Stomach
IMAGING
Radiographic Findings
Fluoroscopic Findings
CT Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Natural History & Prognosis
Indications for Esophagectomy
Risk Factors for Immediate Pulmonary Complications
Post-Esophagectomy Complications
Selected References
- Benjamin G et al: Diaphragmatic hernia post-minimally invasive esophagectomy: a discussion and review of literature. Hernia. ePub, 2015
- van Rossum PS et al: Calcification of arteries supplying the gastric tube: a new risk factor for anastomotic leakage after esophageal surgery. Radiology. 274(1):124-32, 2015
- Christensen JD et al: Imaging of complications of thoracic and cardiovascular surgery. Radiol Clin North Am. 52(5):929-59, 2014
- Sonavane S et al: Expected and unexpected imaging features after oesophageal cancer treatment. Clin Radiol. 69(8):e358-66, 2014
- Devenney-Cakir B et al: Complications of esophageal surgery: role of imaging in diagnosis and treatments. Curr Probl Diagn Radiol. 40(1):15-28, 2011
- Upponi S et al: Radiological detection of post-oesophagectomy anastomotic leak - a comparison between multidetector CT and fluoroscopy. Br J Radiol. 81(967):545-8, 2008
- Kim TJ et al: Postoperative imaging of esophageal cancer: what chest radiologists need to know. Radiographics. 27(2):409-29, 2007
- Upponi S et al: Imaging following surgery for oesophageal cancer. Clin Radiol. 62(8):724-31, 2007
- Kim SH et al: Esophageal resection: indications, techniques, and radiologic assessment. Radiographics. 21(5):1119-37; discussion 1138-40, 2001
