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What are the different ways to perform an esophagectomy?

Lyall A. Gorenstein, MD
Thoracic Surgery (Cardiothoracic Vascular)
In all esophagectomy procedures, the surgeon makes an incision in the abdomen, separates the esophagus from the stomach, and utilizes a portion of the stomach to fashion a replacement esophagus. The remaining portion of the stomach retains its normal function. Additional incisions are made in the chest and/or neck, depending upon the portion of the esophagus that is diseased, as well as the patient's anatomy:
 
  • Trans-hiatal esophagectomy (THE) involves an incision in the abdomen as well as the neck. THE is generally performed for early-stage cancers, and is routinely done minimally invasively.
  • Ivor Lewis esophagectomy (also known as trans-thoracic esophagectomy, or TT) involves an incision in the abdomen as well as the chest. This procedure is employed when the tumor or cancerous tissues are located in the upper part of the esophagus.
  • A three-incision option involves access to the abdomen, the chest, and the neck.

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