Surgery of the Esophagus
Esophageal surgery remains among the most challenging
areas of thoracic surgery. Successful surgical
outcomes require expert diagnosis, experienced
judgment and technical perfection. It is for
esophagectomy (and pancreatectomy) that the recently
described correlation between surgical volume
and outcome is strongest (New
Engl J Med 349:2117-27,
2003); there is little doubt, then, that patients
with esophageal disease should be referred to
specialized centers such as Penn.
The thoracic
surgeons at the University of Pennsylvania
Health System have wide experience in the management
of all aspects of benign and malignant esophageal
disorders. Benign disorders of the esophagus
that Penn thoracic surgeons manage include:
- motility disorders,
- esophageal diverticula,
- hiatal
hernia,
- reflux disease, and
- benign neoplasms such as esophageal
leiomyomata.
We also serve as a regional referral center for
esophageal emergencies including esophageal perforations
and impacted foreign bodies. Our surgeons work
closely with colleagues in gastroenterology and gastrointestinal
radiology to provide all of the available diagnostic studies
including flexible and rigid esophagoscopy, endoscopic ultrasound,
motility studies, video swallowing studies, and pH studies.
More esophageal resections are performed at
Penn than any other health system in the
region. Our surgeons lead a multidisplinary
team of oncologists, radiation therapists and
gastrointestinal pathologists to develop the
optimal treatment plan for each patient.
When surgical resection is indicated, whether
as primary treatment or as part of a multimodality
plan, the goal is both cure and
good functional outcome.
To achieve this,
we select from among all of the available
surgical approaches to the esophagus based
upon the medical condition of the patient
and the extent and location of the tumor.
These approaches include transhiatal
esophagectomy — which is the procedure
performed most frequently at Penn —
Ivor-Lewis esophagectomy, and “3-hole”
esophagectomy. Minimally invasive
options are also available.
For patients who
are not candidates for resection, we provide
a range of palliative options — including
stents, endoscopic photodynamic therapy, and
palliative chemotherapy and/or radiotherapy — aimed at maintaining comfort, restoring
swallowing function, and supporting nutrition.
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