A variety of
surgical procedures are used in the treatment of
esophageal cancer. These procedures include transthoracic
esophagectomy (Ivor Lewis procedure, McKeown procedure, left thoracoabdominal approach), transhiatal
esophagectomy, and various forms of bypass surgery. Although meticulous surgical techniques and improved
postoperative care have markedly reduced the complications associated with these techniques, esophageal resection is still associated with various
intraoperative complications (
hemorrhage, injury to the tracheobronchial tree,
recurrent laryngeal nerve injury) and postoperative complications (
anastomotic leak;
mediastinitis; respiratory problems, including
pleural effusion,
pneumonia, and
acute respiratory distress syndrome; cardiac and functional complications). Postoperative
tumor recurrence is not uncommon in patients undergoing curative resection for
esophageal cancer and can be categorized as either locoregional (locoregional
lymph node metastases, anastomotic recurrence) or distant (hematogenous
metastases, pleural or peritoneal seeding). Hematogenous
metastases most commonly involve the liver, lungs, and bones, followed by the adrenal glands, brain, and kidneys. Hematogenous
metastases may also involve multiple organs simultaneously. The sophisticated
surgical procedures used in
esophagectomy can result in anatomic changes and confound image interpretation. The radiologist must understand how these procedures can affect imaging data and be familiar with the appearances of postoperative anatomic changes, complications, and
tumor recurrence to ensure accurate evaluation of affected patients.