Esophageal Cancer: Diagnosis and Treatment

Contents
About the Editors
Esophageal Anatomy
	Abstract
	Introduction
	Esophageal Anatomy
	Vascularization and Lymphatic Drainage
	Esophageal Surgical Anatomy
		Cervical Esophagus
		Thoracic Esophagus
		Abdominal Esophagus
	Anatomy for Esophageal Replacement
	Esophageal Radiologic Anatomy
		Endoscopic Ultrasound
		Computed Tomography
		Magnetic Resonance
	References
Esophageal Squamous Cell Cancer: Pathogenesis and Epidemiology
	Abstract
	Introduction
	Epidemiology
	Pathogenesis
		Alcohol and Smoking
		Genetic Factors
		Diet and Environment
		Infection
		Premalignant/Neoplastic Condition
		Other Factors
	Prevention
	Conclusion
	References
Esophageal Adenocarcinoma: Pathogenesis and Epidemiology
	Abstract
	Epidemiology
	Pathophysiology: From GERD to Barrett’s Esophagus
	Pathophysiology: From Barrett’s Esophagus to Esophageal Adenocarcinoma
	Conclusions
	References
Endoscopy and Endoscopic Ultrasound for Esophageal Cancer
	Abstract
	Introduction
	Initial Endoscopic Assessment for Esophageal Malignancy
	Barrett’s Esophagus, Dysplasia and Early-Stage Esophageal Cancers
	Endoscopic Treatment of Dysplastic Barrett’s Esophagus
	Endoscopic Resection of Early-Stage Esophageal Cancer
	Endoscopic Ultrasound for Esophageal Cancer
		Initial Clinical Staging
		Accuracy of EUS
		Limitations of EUS
		EUS for Other Benign and Malignant Esophageal Tumors
		Linear EUS and Linear Endobronchial Ultrasound (EBUS)
		EUS for Surveillance
	Endoluminal Stenting
		Esophageal Cancer and Endoluminal Stenting
		Treatment of Esophageal Perforations Related to Cancer
	Endoscopy and Enteral Nutrition
	References
Radiologic Evaluation of Esophageal Cancer
	Abstract
	Introduction
	Tumor “T” Staging
		CT Scan and T Staging
		MRI and “T” Staging
		Endoscopic Ultrasound and “T” Staging
		PET-CT and T Staging
	Node “N” Staging
		CT Scan and N Staging
		MRI and N Staging
		Endoscopic Ultrasound and N Staging
		PET-CT and N Staging
	“M” Staging
		CT Scan and “M” Staging
		MRI and “M” Staging
		PET-CT and “M” Staging
	Conclusions
	References
Staging of Esophageal Cancer: Implications for Therapy
	Abstract
	Introduction
	Overview of Staging Modalities
		Endoscopy
		EUS
		CT Scan
		PET-CT
		Laparoscopy
	Staging and Treatment Algorithm
	References
Endoscopic Management of Early Esophageal Cancer
	Abstract
	Introduction
	Selecting the Appropriate Tumors for Endoscopic Resection
	Diagnostic and Staging Work-Up
	Endoscopic Mucosal Resection (EMR)
	Endoscopic Submucosal Dissection (ESD)
	EMR/ESD Complications
		Bleeding
		Perforation
		Strictures
	Specimen Processing and Histological Evaluation
	Conclusions
	References
Multimodal Therapy for Locally Advanced Esophageal Cancer
	Abstract
	Introduction
	Neoadjuvant Radiotherapy
	Neoadjuvant Chemoradiotherapy or Upfront Surgery
	Can Neoadjuvant Chemoradiotherapy Be Used in Early Esophageal Cancer?
	The Benefit of Neoadjuvant and Perioperative Chemotherapy
	Neoadjuvant Chemotherapy or Chemoradiotherapy
	Safety of Neoadjuvant Chemotherapy and Chemoradiotherapy
	Immunotherapy and Biological Agents
	Completion of Chemotherapy
	References
Definitive Chemoradiotherapy for Esophageal Cancer
	Abstract
	Introduction
	Definitive CRT Versus RT Alone
	Definitive CRT: Which Chemotherapy?
	Definitive CRT Versus Surgery Alone
	Definitive CRT Versus Trimodality Therapy
	Conclusions
	References
Immunotherapy in Esophageal Cancer
	Abstract
	Introduction
	Immunity and Microenvironment of Esophageal Cancer
		Understanding the Complex Tumor Environment
		Molecular Biomarkers for Immunotherapy
	Non-metastatic Esophageal Cancer. Adjuvant and Neoadjuvant Scenario
	Advanced Esophageal Cancer
		First Line
		Second and Subsequent Lines
	Conclusion
	References
Anesthesia for Esophageal Surgery
	Abstract
	Introduction
	Preoperative Evaluation
		Initial Assessment and Testing
		Patient Selection
		Optimization
	Intraoperative Management
		Surgical Approach
		Intraoperative Monitoring
		Induction and Airway Management
		Ventilator Management
		Analgesia
		Fluid Management
		Perfusion of the Esophagogastric Anastomosis
	Postoperative Recovery
		Complications
		Enhanced Recovery Pathway
	Conclusions
	References
Transhiatal Esophagectomy
	Abstract
	Introduction
	Surgical Technique
		Abdominal Phase
		Cervical Phase
		Mediastinal Phase
		Cervical Anastomosis
	Postoperative Course
	References
McKeown Esophagectomy
	Abstract
	Introduction
	Surgical Technique
	Thoracic Phase
	Abdominal Phase
	Cervical Phase
	Creation of Gastric Conduit and Anastomosis
	Adjuncts, Pitfalls and Intraoperative Complications
	Lung Parenchyma and Airway Injury
	Aortic or Major Vascular Injury
	Recurrent Laryngeal Nerve Injury
	Gastric Conduit Ischaemia
	Conclusions
Hybrid (Laparoscopy—Thoracotomy) Esophagectomy
	Abstract
	Introduction
	Surgical Technique
	Laparoscopic Phase
	Thoracic Phase
		Intrathoracic Anastomosis
	Postoperative Course
	References
Laparoscopic and Thoracoscopic Ivor Lewis Esophagectomy
	Abstract
	Introduction
	Operative Technique
	Abdominal Port Placement
	Abdominal Lymphadenectomy and Gastric Mobilization
	Pyloric Drainage and Feeding Jejunostomy
	Transhiatal Dissection
	Creation of the Gastric Conduit
	Positioning for the Thoracic Phase and Port Placement
	Thoracoscopic Dissection
	Esophagogastric Anastomosis
	Postoperative Care
	Outcomes
	Surgical Tips
		Abdominal Phase
		Thoracic Phase
		Intraoperative Trouble Shooting
	References
Robotic Assisted Ivor Lewis Esophagectomy
	Abstract
	Introduction
	Operative Technique
	Abdominal Port Placement and Gastric Mobilization
	Conduit Creation
	Jejunostomy Tube Insertion
	Thoracic Positioning and Port Placement
	Esophageal Mobilization and Esophagogastrostomy
	Postoperative Care
	Intraoperative Troubleshooting
		Port Placement
		Capnothorax
	Outcomes
	References
Minimally Invasive McKeown Esophagectomy
	Abstract
	Introduction
	Preoperative Considerations
	Operative Technique
		Thoracoscopy
		Laparoscopy
		Cervical Phase
	Perioperative Care
	Technical Pitfalls and Complications
		Bleeding
		Splenic Injury
		Airway Injury
		Nerve Injury
	Conduit Necrosis
	Other Postoperative Complications
	References
Colonic Interposition After Esophagectomy
	Abstract
	Introduction
	Indications
	Preoperative Evaluation
	Patient Position
	Preparation of the Left Colon
	Cervicotomy
	Colon Conduit Pull-Up
		Posterior Mediastinum Route
		Retrosternal Route
		Subcutaneous Route
	Abdominal Anastomoses
	Right Colon: Technical Differences
	Postoperative Care
	Outcomes
	Surgical Tips
	References
Perioperative Care and Management  of Post-operative Complications
	Abstract
	Introduction
	Preoperative Management
		Patient Education
		Smoking Cessation
		Exercise
		Carbohydrate Loading
		Assessment of Risk for Postoperative Nausea and Vomiting
	Predictors of Perioperative Complications
		Pulmonary
		Cardiovascular
	Intraoperative Management
		Fluid Administration
		Maintenance of Body Temperature
		Anesthetic Considerations
	Postoperative Management
		Pain Management
		Early Mobilization
		Diet and Nutrition
		Routine Postoperative Anastomotic Evaluation
	Management of Postoperative Complications
		Pulmonary
		Atrial Fibrillation
		Chylothorax
		Anastomotic Leak
		Delayed Gastric Emptying
	Conclusions
	References
Quality of Life After Esophagectomy
	Abstract
	Introduction
		Preoperative Comorbid Conditions
		Neoadjuvant Therapy
		Postoperative Complications
		Operative Approach and HRQL
		Esophageal Cancer Surgery: Importance of Center and Surgeon Volume
	Conclusions
	References
Palliative Treatment of Esophageal Cancer
	Abstract
	Introduction
	Palliative Treatment of Esophageal Cancer
		Chemotherapy and External Beam Radiation
		Endoscopic Dilation and Stenting
		Brachytherapy
		Endoscopic Ablative Techniques
		Surgical Palliation
	Conflicts of Interest
	References
Index