Improvements in tools and techniques, anesthetic practices, and surgical approaches, such as transhiatal esophagectomy (THE) and cervical esophago-gastric anastomosis (CEGA), have contributed to better outcomes for persons having esophageal surgery (Annals of Surgery, August 2000: 232(2); 225-232). Surgical approaches differ in location of the incisions and in the methods used to remove the esophagus. The traditional approach involves an incision in the chest.
A transhiatal esophagectomy incision is in the neck, which prevents complications related to having an incision in the chest. Both pneumonia and mediastinitis, a serious infection in the chest, are less likely with transhiatal esophagectomy, because it is easier to cough and breathe deeply after surgery. The transhiatal procedure is also effective in surgical candidates who are obese (The Annals of Thoracic Surgery, August 2007: 84: 376-383).
Cervical esophago-gastric anastomosis, or CEGA, allows surgeons to more easily access the section of esophagus that can potentially leak after surgery. This is important if a leak is suspected because it can be more easily repaired than with a traditional trans-thoracic esophagectomy (Surgery, 2004 Oct; 136(4): 917-925).
Other studies report that the minimally invasive approach or thoracoscopic technique is also a viable option for some patients (Annals of Surgery, October 2003: 238(4); 486-495; Annals of Thoracic Surgery, 2005; 80: 2070-2075).