ESOPHAGEAL RESECTIONESOPHAGEAL RESECTION

DR V JONKERDR V JONKER

Dept cardiothoracic SurgeryDept cardiothoracic Surgery

Yunivesithi Ya FreistataYunivesithi Ya Freistata

PREOP EVALUATIONPREOP EVALUATION

Physiologic evaluationPhysiologic evaluation Radiological evaluation – contrast, Radiological evaluation – contrast,

endoscopy, CT, bronchoscopyendoscopy, CT, bronchoscopy EUSEUS Thoracoscopy, LaparoscopyThoracoscopy, Laparoscopy Lung functionsLung functions Cardiac echo/ stress testCardiac echo/ stress test

TYPES OF RESECTIONTYPES OF RESECTION

IVOR LEWIS ESOPHAGECTOMYIVOR LEWIS ESOPHAGECTOMYINDICATIONSINDICATIONS

High grade dysplasiaHigh grade dysplasiaCarcinomaCarcinomaCaustic injuryCaustic injury

Not for upper 1/3 caNot for upper 1/3 caLaparotomyLaparotomyThoracotomyThoracotomyMcKeown Modification - ® Cervical McKeown Modification - ® Cervical incisionincision

(L) TRANSTHORACIC APPROACH(L) TRANSTHORACIC APPROACH

RADICAL EN-BLOCK RESECTIONRADICAL EN-BLOCK RESECTION

THREE-FIELD NODAL DISSECTIONTHREE-FIELD NODAL DISSECTION

Postoperative coursePostoperative course– VentilationVentilation– DiuresisDiuresis– MobilizationMobilization– NG tube removal/ Jejunostomy feedingNG tube removal/ Jejunostomy feeding– Postop Barium Swallow- day 6Postop Barium Swallow- day 6– Remove J-tube 4 weeks postopRemove J-tube 4 weeks postop

COMPLICATION MANAGEMENTCOMPLICATION MANAGEMENT– Anastomosis leakAnastomosis leak– Anastomotic strictureAnastomotic stricture– Delayed gastric emptyingDelayed gastric emptying– RefluxReflux

ORRINGER ORRINGER TRANSHIATAL TRANSHIATAL ESPOHAGECTOMYESPOHAGECTOMYOrringer vs Ivor LewisOrringer vs Ivor Lewis3 Phases3 Phases

AbdominalAbdominalMediastinalMediastinalCervicalCervical

COLONIC COLONIC INTERPOSITIONINTERPOSITION

IndicationsIndications(L) Colon preferable(L) Colon preferableColon vs StomachColon vs StomachComplicationsComplications

JEJUNUM INTERPOSITIONJEJUNUM INTERPOSITIONIndicationsIndicationsChildrenChildren

FREE INTESTINL TRANSFERFREE INTESTINL TRANSFERMINIMALLY INVASIVE MINIMALLY INVASIVE

ESOPHAGECTOMYESOPHAGECTOMY