Esophageal surgery in the 21st century
The esophagus has often been considered an unforgiving organ. Traversing 3 body regions, lacking adventitia, harboring complex innervation, lymphatics and blood supply are some of the factors making esophageal surgery a complex surgery with notorious reputation given its significant morbidity and mortality profile.
By the end of the last century, mortality rate ranging up to double digit rate was a norm in many centers in which esophagectomy was performed (1). As a consequence, many referring physicians considered certain conditions to be non-operable, sentencing many patients to a symptomatic, miserable poor quality of life and shortened survival (2).
Like most fields in surgery, there have been marked improvements in modern-era foregut surgery and specifically, esophageal surgery. As more surgeons became familiar with the unique anatomy and physiology of the esophagus, pioneers improved surgical techniques which together with early recognition of surgical complications and improvement of perioperative care reduced the rate of complications and mortality of these complex surgeries. Advanced training and specialized fellowship programs yielded a larger number of surgeons with expertise and thus further improved overall outcomes.
Since the first attempted morbid esophagectomy was described at the end of the 19th century, long way has passed till nowadays where esophageal surgeons are performing tissue based precise surgical interventions.
Modern platforms and less invasive technologies, such as combined laparoscopy/thoracoscopy, robotic surgery, and other innovations such as endoscopic fundoplication and myotomy have become the “bread and butter” of the foregut surgeon.
With this in mind, this special edition of the Annals of Translational Medicine features contributions from experts in esophageal surgery, radiology and medical oncology.
These distinguished leaders describe the most up-to-date indications, approaches and techniques of some of the most common benign diseases of the esophagus, as well as curative and palliative approaches to manage esophageal malignancies, and some unique circumstance of emergent esophageal surgery. Details of complex endoscopic and minimally invasive platforms are described. Updates in esophageal oncology and radiology as well as data and experience with extended indications and complex situations such as esophageal surgery in lung transplant and morbidly obese patients are reported. Lastly, the newest innovations of fluorescence-guided esophageal surgery and the most challenging esophageal replacement and transplantation are detailed.
With the goal of serving our patients best by providing them expert and up-to-date care, we hope all physicians- general and thoracic surgeons, gastroenterologists, radiologists and oncologists, will find this concise but thorough review helpful and interesting.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Translational Medicine, for the series “Innovations and Updates in Esophageal Surgery”. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-6642). The series “Innovations and Updates in Esophageal Surgery” was commissioned by the editorial office without any funding or sponsorship. OW served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Annals of Translational Medicine from Oct 2019 to Sep 2021. The author has no other conflicts of interest to declare.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Gockel I, Exner C, Junginger T. Morbidity and mortality after esophagectomy for esophageal carcinoma: a risk analysis. World J Surg Oncol 2005;3:37. [Crossref] [PubMed]
- Steyerberg EW, Neville B, Weeks JC, et al. Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol 2007;25:2389-96. [Crossref] [PubMed]
