Esophageal resection: Indications, techniques, and radiologic assessment

Various surgical procedures are performed for benign and malignant esophage al lesions. These procedures include transthoracic esophageal resection thr ough a right or left thoracotomy and transhiatal blunt esophageal resection (esophagectomy) without thoracotomy. The whole stomach, colon, gastric tub e, jejunum, and free revascularized grafts may be used as substitutes for t he resected esophagus. Bypass procedures including substernal stomach bypas s surgery and substernal or subcutaneous colon bypass surgery are performed for tracheoesophageal fistula, previous esophagectomy without reconstructi on, or obstruction due to lye ingestion. The mortality rate for esophageal resection depends on the stage of the tumor, the patient's condition, and t he surgeon's skill and is quite low when the procedure is performed by a hi ghly skilled surgeon. The most frequent sources of morbidity related to eso phageal surgery include pneumothorax, pleural effusion, pneumonia, and resp iratory failure. Mediastinitis and sepsis due to disruption at an anastomos is site cause serious postoperative morbidity and mortality; therefore, tho racic anastomotic leaks require aggressive surgical treatment. Familiarity with these surgical options, the resultant anatomic changes associated with each option, and the expected findings at postoperative imaging is essenti al for evaluating the effectiveness of surgical procedures and for the earl y detection and management of surgery-related complications.