Today esophageal cancer is one the fastest growing digestive cancer worldwide and is changing from a predominantly squamocellular cancer to adenocarcinoma related to chronic reflux disease.

This lecture presents esophagectomy’s indications and techniques and approaches and the role that endoscopy plays in this field. First described by Torek in 1913 using a rubber tube for conduit reconstruction, esophagectomy is probably still nowadays one of the largest and most invasive procedure performed by digestive and thoracic surgeons. The whole stomach, colon, gastric tube, jejunum, and free revascularized grafts may be used as substitutes for the resected esophagus. Although the mortality rate is quite low (between 2 and 5%) in large high volume centers, the morbidity rate for esophageal resection is around 50%. The most frequent sources of morbidity related to esophageal surgery include pneumothorax, pleural effusion, pneumonia, and respiratory failure. Mediastinitis and sepsis due to disruption at an anastomosis site cause serious postoperative morbidity and mortality; therefore, thoracic anastomotic leaks require immediate aggressive treatment.

Familiarity with these surgical options, the resultant anatomic changes associated with each option, and the expected findings at postoperative imaging including endoscopy is essential for evaluating the effectiveness of surgical procedures and for the early detection and management of surgery-related complications.