Optimal surgical approach for esophagectomy: the debate still goes on?

Address reprint requests to Simon Law, MS, MA (Cantab), MBBChir, FRCS (Edin), FCSHK, FHKAM, FACS: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. ©2009 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved. Surgical resection remains the mainstay treatment for patients with localized esophageal cancer. In dedicated centers, esophagectomy has become a safe operation with a mortality rate of 2%–3%. A volume-outcome relationship is demonstrated. However, many controversies remain in regard to the treatment of esophageal cancer, and the optimal approach for esophageal extirpation is still an area of debate. Several methods of surgical access exist for esophagectomy, including right or left thoracotomy, transhiatal approach, and laparoscopy, thoracoscopy, mediastinoscopy, and their combinations. Some of these issues are discussed in this article.