Esophagogastrectomy is usually performed for high-grade dysplasia or carcinoma of the esophagus, particularly of the middle and lower thirds. Less common indications for this procedure are nondilatable stricture of the distal esophagus requiring resection and rupture of the esophagus that is irreparable.

Two separate incisions are generally used: abdominal and right thoracic. A left thoracotomy or left thoracoabdominal incision may be used for carcinoma of the distal esophagus and the gastroesophageal junction. A combined laparoscopic/thoracoscopic approach is currently undergoing clinical evaluation but is still considered experimental, while the open approach remains the gold standard. To mobilize the stomach, the short gastric, left gastroepiploic, and left gastric arteries are sacrificed, and the blood supply through the right gastroepiploic and right gastric arteries is preserved. The distal line of resection in the proximal stomach is securely closed and an esophagogastric anastomosis is performed on the anterior surface of the stomach below the line of resection. Feeding jejunostomy with pyloroplasty or pyloromyotomy may be done. Surgical stress is great and the procedure has relatively high morbidity and mortality rates. Anesthesia is endotracheal, using a double lumen tube to allow the lung on the side of the operation to remain collapsed. The procedure takes 4 to 6 hours and requires 2 to 4 units of blood.

Usual postoperative course

Expected postoperative hospital stay

Seven to 10 days.

Operative mortality

The operative mortality rate is approximately 4%–5%.