Basic Principles of Esophageal Surgery. 1 Surgical Anatomy of the Esophagus... 3

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1 Contents Basic Principles of Esophageal Surgery 1 Surgical Anatomy of the Esophagus... 3 D. C. Broering, J. Walter, Z. Halata ] Topography of the esophagus... 3 ] Development of the esophagus... 4 ] Structure of the esophagus The Esophagus Diagnostic Methods of Examination G. Krupski, V. Nicolas ] Conventional methods of examination ] Diverticula ] Achalasia ] Gastroesophageal reflux and hernias ] Varices ] Foreign bodies ] Esophageal tumors ] CTandMRI Endoscopic Examination of the Esophagus K. F. Binmoeller, B. Brand, N. Soehendra ] Introduction ] Equipment and normal anatomy ] Malignant tumors ] Benign tumors ] Esophagitis ] Complications of esophagitis ] Varices and other sources of upper gastrointestinal bleeding ] Diverticula ] Achalasia and other motor disorders ] References... 24

2 X ] Contents 4 Role of Endoscopic Ultrasound for Diagnosis and Staging of Esophageal Cancer A. Fritscher-Ravens, M.X. Pelling ] Introduction ] Principles of EUS tumor staging ] Examination technique and instrumentation ] EUS compared to other imaging techniques ] EUS and tumor stenosis ] EUS and re-staging of esophageal cancer ] Endoscopic ultrasound in early tumor stages ] Endoscopic ultrasound guided fine needle aspiration ] Conclusion ] References Preoperative Evaluation of the Operative Risk Profile K. A. Gawad, C. Busch, D.C. Broering, E.F. Yekebas ] Introduction ] Definition of risk ] Methods of risk ascertainment ] Measures for preoperative risk minimization ] References Perioperative and Postoperative Management J. Scholz, P. H. Tonner, G. von Knobelsdorff ] Preoperative evaluation ] Postoperative phase ] References Pathophysiology of Gastroesophageal Reflux Disease and Indication for Surgical Therapy K.-H. Fuchs ] Introduction ] Definition ] Theantirefluxbarrier ] Esophageal peristalsis ] Mucosal resistance ] Duodeno-gastroesophageal reflux ] Gastroduodenal disorders ] Indication for surgery ] Conclusions ] References... 55

3 Contents ] XI 8 Gastroesophageal Reflux and its Surgical Management G. G. Jamieson, D. I. Watson ] Introduction ] Which patients should be considered for antireflux surgery? ] What are the advantages and disadvantages of antireflux surgery? ] Operations available ] Traditional open fundoplication ] Laparoscopic fundoplication ] Laparoscopic versus open surgery ] Randomzied trials of laparoscopic antireflux surgery ] Controversies and questions in regard to laparoscopic antireflux surgery 65 ] Why do antireflux operations sometimes fail ] When do antireflux operations fail? ] Re-operative surgery for failed antireflux procedures ] References Pathologic Classification of the Esophageal Carcinoma P. Hermanek ] Tumor classification ] Tumor site ] Typing ] Grading ] TNM/pTNM classification ] Requirement for ptnm classification of esophageal carcinoma (UICC 2002, 2003) ] Additional descriptors and optional categories of the TNM system ] Residual tumor (R) classification ] Grading of histological regression after neoadjuvant treatment ] Preconditions for adequate histopathological tumor classification ] References Lymphatic Dissemination and Principles of Lymph Node Dissection J.R. Izbicki, A. Rehders, A. Kutup, C. Busch ] Anatomy of the lymphatic system ] Operative procedure ] References... 86

4 Contents ] XI 8 Gastroesophageal Reflux and its Surgical Management G. G. Jamieson, D. I. Watson ] Introduction ] Which patients should be considered for antireflux surgery? ] What are the advantages and disadvantages of antireflux surgery? ] Operations available ] Traditional open fundoplication ] Laparoscopic fundoplication ] Laparoscopic versus open surgery ] Randomzied trials of laparoscopic antireflux surgery ] Controversies and questions in regard to laparoscopic antireflux surgery 65 ] Why do antireflux operations sometimes fail ] When do antireflux operations fail? ] Re-operative surgery for failed antireflux procedures ] References Pathologic Classification of the Esophageal Carcinoma P. Hermanek ] Tumor classification ] Tumor site ] Typing ] Grading ] TNM/pTNM classification ] Requirement for ptnm classification of esophageal carcinoma (UICC 2002, 2003) ] Additional descriptors and optional categories of the TNM system ] Residual tumor (R) classification ] Grading of histological regression after neoadjuvant treatment ] Preconditions for adequate histopathological tumor classification ] References Lymphatic Dissemination and Principles of Lymph Node Dissection J.R. Izbicki, A. Rehders, A. Kutup, C. Busch ] Anatomy of the lymphatic system ] Operative procedure ] References... 86

5 XII ] Contents 11 Rationale for Type of Resection in Cancer of the Esophagus and Gastroesophageal Junction W. T. Knoefel, I. Alldinger, J.R. Izbicki ] Tumor typing ] Anatomiclocation ] Cervical esophagus ] Upper thoracic esophagus ] Lower thoracic esophagus ] Tumors of the gastroesophageal junction ] Limited resections ] Palliative esophageal resection ] Recurrences ] Summary ] References Results of Extended en bloc Esophagectomy in Treatment of Patients with Esophageal Cancer D. I. Watson, G. G. Jamieson ] Rationale for extended en bloc esophagectomy ] Proposed advantages and disadvantages for extended en bloc esophagectomy ] Results of standard esophagectomy ] Results of 2 field (en bloc) esophagectomy ] Results of extended 3 field esophagectomy ] Case selection and peri-operative outcomes for 3 field esophagectomy. 100 ] Complications following 3 field esophagectomy ] Lymph node metastases to the cervical nodes found by 3 field lymphadenectomy ] Survival following esophagectomy ] Randomized trials of extended 3 field esophagectomy versus 2 field en bloc esophagectomy ] Use of 3 field en bloc esophagectomy for adenocarcinoma of the esophagus ] Conclusions ] References

6 Contents ] XIII Surgical Techniques 13 Blunt Transhiatal Subtotal Esophagectomy with Gastroplasty and Cervical Anastomosis E. F. Yekebas, A. F. Chernousov, D. C. Broering, P. M. Bogopolski, C. F. Eisenberger, A. Kutup, J.R. Izbicki ] Blunt transhiatal esophagectomy and substitution by gastric tube ] Complications of transhiatal blunt esophageal dissection and gastric pull-up Partial Abdominothoracic Resection of the Esophagus with Gastroplasty and Intrathoracic Anastomosis A.F. Chernousov, A. Kutup, P.M. Bogopolski, D. C. Broering ] Indications Abdominothoracic Subtotal en bloc Esophagectomy and Reconstruction with Gastric Tube Transposition J.R. Izbicki, D. C. Broering, P. Kaudel, A. Kutup, E.F. Yekebas 16 Fundus Rotation Gastroplasty M. K. Schilling, M. W. Buechler 17 Proximal Gastrectomy with Distal Esophagectomy (Proximal Resection) A. F. Chernousov, O. Zehler, P. M. Bogopolski, D. C. Broering, H. W. Schreiber{ 18 Transhiatal Esophagogastrectomy J.R. Izbicki, D. C. Broering, A. Kutup, E.F. Yekebas 19 Colon Interposition after Total and Subtotal Esophagectomy J.R. Izbicki, K. Steffani, A.F. Chernousov, P. M. Bogopolski, D. C. Broering, H.W. Schreiber{ ] Complications after subtotal or total esophagectomy with colonic interposition Intrathoracic Esophagoplasty by Colon Interposition A. F. Chernousov, P. M. Bogopolski, H. W. Schreiber{, D. C. Broering 21 Reconstruction of Gastrointestinal Continuity by Jejunal Interposition following Total and Subtotal Esophagectomy A. F. Chernousov, P. Schurr, P. M. Bogopolski, D. C. Broering, H. W. Schreiber{

7 XIV ] Contents 22 Limited en bloc Resection of the Gastroesophageal Junction with Isoperistaltic Jejunal Interposition J.R. Izbicki, W.T. Knoefel, D. C. Broering 23 Conventional Cardiomyotomy in Achalasia K. A. Gawad, D. C. Broering, C. Busch 24 Surgical Technique in Gastroesophageal Reflux Disease Conventional Approach ] Introduction and Techniques in gastroesophageal reflux K. A. Gawad, D. C. Broering, C. Bloechle, C. Busch ] Techniques in peptic stricture and hiatal hernia A.F. Chernousov, P. M. Bogopolski, K. A. Gawad 25 Conventional Resection of Esophageal Diverticula A. F. Chernousov, C. F. Eisenberger, P. M. Bogopolski, J. R. Izbicki, H.W. Schreiber{ ] Epiphrenic diverticulum ] Preparation of a diaphragmatic flap for enforcement of the esophageal wall after resection of an epiphrenic diverticulum Local Excision of Benign Esophageal Tumors A.F. Chernousov, A. Kutup, P.M. Bogopolski, H.W. Schreiber{ 27 Surgical Treatment of Esophageal Fistula and Perforation A.F. Chernousov, N. Roch, P.M. Bogopolski, D.C. Broering, H.W. Schreiber{ ] Fistulas of the esophagus ] Cervical fistulas of the esophagus ] Intrathoracic esophago-tracheal fistula ] Intrathoracic fistulas ] Intraabdominal fistulas of the esophagus ] Esophagopleural fistulas Techniques of Local Esophagoplasty A.F. Chernousov, A. Kutup, P.M. Bogopolski, H.W. Schreiber{

8 Contents ] XV 29 Minimal Invasive Surgery of the Esophagus H. Feussner, R. Bumm, T. Olah ] Introduction ] Diverticula of the esophagus ] Minimal invasive treatment of esophageal motility disorders ] Antireflux surgery ] Excision of benign tumors ] Minimally invasive procedures in esophageal carcinoma Endoscopic Technique in the Treatment of Esophageal Diseases Y. I. Gallinger, M. Rehner, F. M. Steichen, N. Soehendra ] Hemorrhage and esophageal varices ] Foreign bodies and bolus obstruction ] Resection of tumors ] Photodynamic therapy of tumors (PDT) ] Obstructions by malignant tumors ] Esophageal fistula ] Dilatation of benign stenoses ] Stenotic esophageal anastomoses and membranes (webs) ] Achalasia ] Diverticula ] References Post-operative Complications of the Esophagus and Esophagus Bridge Graft D. C. Broering, J. R. Izbicki, Y. Vashist, A. F. Chernousov, P. M. Bogopolski, E. F. Yekebas ] Early post-operative complications ] Late post-operative complications Subject Index