Esophagectomy. The role of the intrathoracic anastomosis.

Esophagectomy for carcinoma continues to play a vital role in the treatment of patients with esophageal carcinoma. Safe resection with minimal short-term mortality and good swallowing palliation can be performed via the use of multiple, well-described resection techniques. Tumor location and the possibility of direct mediastinal invasion may dictate the need for transthoracic dissection and extension of the resection to the cervical esophagus for ideal margins. Differences in survival, short-term outcome, and swallowing function have yet to be proven for procedures with extended lymph node dissection versus those with minimal intrathoracic or cervical node dissections. The surgeon's ability and familiarity with various techniques may enhance the overall treatment of the patient with esophageal carcinoma as their treatment becomes more directed by the initial pathologic stage at presentation.