Vagal-sparing esophagectomy: is it a useful addition?

A vagal sparing esophagectomy should be considered for patients with end-stage benign disease and Barrett's high-grade dysplasia or intramucosal adenocarcinoma. No lymphadenectomy is performed with this procedure, so it is not applicable to cancers invasive into the submucosa. Advantages of a vagal-sparing procedure over a standard esophagectomy with gastric pull-up include its simplicity to perform, ability to be done as a laparoscopic procedure, lack of requirement for single-lung ventilation or mediastinal dissection, avoidance of the need for a pyloroplasty, and preservation of the vagus nerves. Given these advantages, a vagal-sparing esophagectomy should be the preferred method of esophageal resection in appropriate patients.