Vagal-Sparing Esophagectomy

Abstract

Survival with intramucosal adenocarcinoma or Barrett's with high-grade dysplasia is independent of the type of resection. A vagal-sparing esophagectomy is associated with significantly less perioperative morbidity and a shorter hospital stay than a transhiatal or en bloc esophagectomy. Further, late morbidity including weight loss, dumping, and diarrhea are significantly less likely after a vagal-sparing approach. Consequently a vagal-sparing esophagectomy is the preferred procedure for patients with intramucosal adenocarcinoma or high grade dysplasia.

Endoscopic and Surgical Treatment of Mucosal (T1a) Esophageal Adenocarcinoma in Barrett's Esophagus

“…In addition, the learning curve of this procedure is steep, limiting generalizability. Vagal sparing esophagectomy is a technique wherein the vagus nerve is spared by removing the esophagus without regional lymphadenectomy, leaving the vagal innervation of the distal stomach intact: a technique thought to be ideal for patients with HGD and intramucosal adenocarcinoma who have a low risk of metastatic lymphadenopathy 28 . However in a study comparing the outcomes of this technique with the Ivor Lewis technique and the transhiatal technique, a 30 day mortality of 2% and an overall morbidity rate of 30% were reported.…”

“…Patients with mucosal EAC however appear to have better outcomes with both endoscopic and surgical series describing 5 year survival rates exceeding 80% 6, 12, 28, 29 . Factors predictive of survival after esophagectomy include absence of metastatic lymphadenopathy 6 , tumor histology, achieving clear margins (R0 resection), response to chemoradiotherapy and stage of the tumor 3 .…”

Reflux esophagitis, high-grade neoplasia, and early Barrett’s carcinoma—what is the place of the Merendino procedure?

“…In patients with pT1a adenocarcinomas, this operation showed the same long-term results as more radical esophagectomies [47,55,56]. However, this procedure seems to be quite extensive, as a large portion of the sound esophagus is removed.…”

SSAT Controversies Intramucosal Esophageal Cancer and High-Grade Dysplasia: Which Treatment?

“…11 Outcomes may be even better following vagal sparing esophagectomy. 15 So where do we stand? Endoscopic therapy can and should be embraced with enthusiasm.…”