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Surgical management of resectable esophageal and esophagogastric junction cancers

Scott Swanson, MD
Section Editor
Kenneth K Tanabe, MD
Deputy Editors
Wenliang Chen, MD, PhD
Diane MF Savarese, MD


Esophageal cancer presents as localized disease, defined as adenocarcinoma or squamous cell carcinoma confined to the esophagus, in approximately 22 percent of all cases [1]. Regional disease, which includes spread to regional lymph nodes, accounts for another 30 percent of patients with esophageal cancer. The goal of surgical management is curative, and a surgical resection is the traditional mainstay of multidisciplinary therapy for patients with localized disease [2-5]. The clinical spectrum of esophageal cancer has changed over the last few decades, with an increase in incidence of adenocarcinoma and a decrease of squamous cell carcinoma [6-11]. Surgical management is independent of histology.

The selection criteria and surgical management of patients with esophageal cancer are discussed in this topic. Neoadjuvant and adjuvant chemotherapy and radiation therapy, and management of patients with unresectable esophageal cancer are reviewed separately (See "Radiation therapy, chemoradiotherapy, neoadjuvant approaches, and postoperative adjuvant therapy for localized cancers of the esophagus" and "Management of locally advanced unresectable and inoperable esophageal cancer".)


The esophagus, approximately 25 to 30 cm in length, is located in the posterior mediastinum and extends from the level of the 7th cervical vertebra to the 11th thoracic vertebra (figure 1 and figure 2 and figure 3). It is divided into four anatomic areas including cervical, thoracic, lower thoracic/esophagogastric junction, and the abdominal esophagus (figure 4 and figure 5 and figure 6). The esophagus is composed of the mucosa, submucosa, muscularis externa, and adventitia (image 1). There are three critical anatomic points of narrowing: the cricopharyngeus muscle, the broncho-aortic constriction, and the esophagogastric junction, which are also the most common sites of iatrogenic and mechanical perforation (figure 7 and figure 8) [12].

The arterial supply includes the inferior thyroid artery (cervical esophagus), bronchial arteries and the aorta (thoracic esophagus), and branches of the left gastric artery and inferior phrenic artery (abdominal esophagus) (figure 9). The venous drainage is through the inferior thyroid vein (cervical esophagus); the azygous vein, the hemiazygous vein, or the bronchial veins (thoracic esophagus); and the coronary vein (abdominal esophagus) (figure 10).

The esophagus has a rich network of lymphatic channels in the submucosa that can facilitate the longitudinal spread of neoplastic cells along the esophageal wall. Lymphatic drainage is to cervical nodes, tracheobronchial and mediastinal nodes, and gastric and celiac nodes (figure 11).


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