Cancer of the Esophagus – Transhiatal Total Esophagectomy

A 44-year-old man with a long history of gastroesophageal reflux disease and esophagitis, started experiencing difficulty in swallowing, initially in solid food, but later with liquid food as well. He underwent esophagogastroscopy, which revealed a large, irregular mass protruding inside the esophagus at its lower end, just above its junction with the stomach. Biopsy confirmed cancer of the esophagus. CT-scan also showed a large tumor in the lower esophagus. In order to achieve maximal radicality (tumor clearance) of the eventual operation and an improved overall outcome, preoperative chemotherapy was offered. Indeed, after even the first chemotherapy, the patient experienced improvement in his swallowing, which indicated a good response. After the third chemotherapy, he was able to eat normally again and a repeat CT scan demonstrated significant shrinking of the tumor. At that point, he was taken to the operating room, where removal of his whole esophagus was performed. We were able to achieve this by using only two incisions: one in the abdomen, and one in the neck. It is important to note that a chest incision (or, “thoracotomy”) was not performed, so all the discomfort and the possible complications associated with such an incision were prevented. His postoperative course was very good and was discharged for home on the 8th postoperative day in very good condition.

Diagnostic
esophagogastroscopy

Upper endoscopy: Cancer of the esophagus

The carcinoma of the esophagus is shown.

Computerized Tomography (CT)
before chemotherapy

Large sized esophageal carcinoma before chemotherapy

The large size of the esophageal cancer can be appreciated.

Computerized Tomography (CT)
after chemotherapy

Significant shrinking of the esophageal cancer after chemotherapy

Significant shrinking of the esophageal cancer after chemotherapy.

Total esophagectomy -
Operative specimen

Total esophagectomy with complete lymph node dissection and resection of portion of the stomach

Total esophagectomy with complete lymph node dissection and resection of portion of the stomach.

Postoperative radiograph:
Replaced esophagus

Gastric tube in replacement of the resected esophagus

Gastric tube in replacement of the resected esophagus.