What is Laparoscopic Esophageal Cancer Surgery?

A surgical procedure to remove some or all of the swallowing tube between your mouth and stomach (esophagus) and then reconstruct it using part of another organ, usually the stomach. Esophagectomy is a common treatment for advanced esophageal cancer and is used occasionally for Barrett’s esophagus if aggressive precancerous cells are present. An esophagectomy may also be recommended for noncancerous conditions when prior attempts to save the esophagus have failed, such as with end-stage achalasia or strictures, or after ingestion of material that damages the lining of the esophagus.

laparoscopic esophageal surgery is brief, spanning just 9 years. In separate reports in 1991, Dallemagne et al15 and Geagea28 described laparoscopic fundoplication. In the same year, Shimi et al67 reported on laparoscopic esophageal myotomy. Two years later, in a multicenter study, Cuschieri et al13 documented the outcome of laparoscopic fundoplication in a series of more than 100 patients. Since that time, minimally invasive techniques have been used in the treatment of virtually all surgical diseases of the esophagus.

Despite its short history, laparoscopic esophageal surgery is now second only to biliary tract surgery in the frequency of minimally invasive procedures performed in everyday surgical practice. Laparoscopic fundoplication has assumed a central role in the surgical treatment of gastroesophageal reflux disease (GERD) and is significantly altering the balance of therapy toward more common and earlier surgical intervention. The role of laparoscopic treatment of esophageal achalasia and other esophageal motor disorders continues to be refined, with minimally invasive surgical techniques also shifting treatment decisions for these patients. Other less common procedures, including laparoscopic staging of foregut malignancy, minimally invasive esophageal diverticulectomy, and laparoscopic-assisted or thoracoscopic-assisted esophagectomy, are undergoing cautious clinical trial.

Why Laparoscopic Esophageal Cancer Surgery done?

Esophagectomy is the main surgical treatment for esophageal cancer. It is done either to remove the cancer or to relieve symptoms.

During an open esophagectomy, the surgeon removes all or part of the esophagus through an incision in the neck, chest or abdomen. The esophagus is replaced using another organ, most commonly the stomach but occasionally the small or large intestine.

In most circumstances, esophagectomy can be done with minimally invasive surgery, either by laparoscopy, robot assisted or a combination of these approaches. When the individual situation is appropriate, these procedures are done through several small incisions and can result in reduced pain and faster recovery than conventional surgery.

Laparoscopic Esophageal Cancer Antireflux Surgery

The serendipitous discovery by Rudolf Nissen in 1956 that a patch of gastric fundus wrapped around the distal esophagus would alleviate GERD catalyzed the development of open antireflux surgery.53 Over the subsequent 3 decades, fundoplication underwent several refinements as attempts were made to ameliorate postoperative sequelae directly attributable to excessive competence of the gastroesophageal junction (GEJ). It was concluded that the optimal wrap should be 1 cm to 2 cm in length and

Why Patient Selection Laparoscopic Esophageal Cancer Surgery?

Antireflux surgery is indicated for the treatment of objectively documented, relatively severe GERD. Candidates for surgery include not only patients with erosive esophagitis, stricture, and Barrett’s esophagus but also those without severe mucosal injury who are dependent on proton-pump inhibitors for symptom relief (Fig. 1). Patients with atypical or respiratory symptoms who have a good response to intensive medical treatment are also candidates. The option of antireflux surgery should be

PARAESOPHAGEAL HERNIA

Hiatal hernias traditionally are classified according to their anatomic characteristics into types 1, 2, and 3.30 Type 1 hernias are the most common (90%) and are characterized by cephalad displacement of the GEJ. In a true paraesophageal hernia (type 2), the GEJ is sited in its normal position within the abdomen, but the fundus is herniated into the thorax. This variant is the least commonly encountered. Finally, in a type 3, or mixed, hernia, elements of types 1 and 2 are present, that is,

Laparoscopic Esophageal Myotomy

Dysphagia is the primary symptom of esophageal motor disorders. Its perception by patients is a balance between the severity of the underlying abnormality causing the dysphagia and the adjustment made by patients in altering eating habits. A surgical myotomy is designed to improve the symptoms of dysphagia caused by a motility disorder. The results can improve profoundly a patient’s ability to ingest food but rarely returns the function of the foregut to normal. The principle of the procedure

Laparoscopic Staging of Carcinoma of the Esophagus

Several reports have emerged reporting the utility of laparoscopy and thoracoscopy in the staging of foregut malignancy. Stein et al73 have attempted to sort out the utility of laparoscopic staging in patients with foregut cancer. The investigators prospectively assessed the value of minimally invasive surgical staging in 127 consecutive patients with cancer of the esophagus and cardia. Diagnostic laparoscopy and laparoscopic sonography revealed previously unknown findings in 22% to 25% of

Laparoscopic Collis Gastroplasty

In patients with esophageal shortening, a Collis gastroplasty may be necessary to effect a tension-free repair. A review of patients with end-stage GERD treated at the authors’ institution by open Collis-Belsey procedure revealed that, in addition to esophageal shortening, 60% of patients had poor esophageal body motility and 23% had a persistent stricture (Fig. 11).62 Johnson et al,44 Jobe et al,42 and Swanstrom et al75 have shown that Collis gastroplasty is technically feasible by