Esophagectomy after previous pancreatic surgery - challenges and approaches

Esophagectomy (EE) is the mainstay for a curative treatment of esophageal cancer. Reconstruction after EE poses specific challenges, especially in patients with a history of upper abdominal procedures, such as pancreatic resections. Adhesions, altered anatomy, and, most notably, changes in blood supply are the main concerns. The gastroepiploic arcade is particularly interesting due to its vulnerability during pancreatic surgery, where it is often divided, and its importance in the blood supply of a potential gastric conduit. Furthermore, functional aspects, as well as diabetes, gastroparesis, and malassimilation following pancreatic surgery, can complicate peri- and postoperative management. An adequate preoperative preparation with particular attention to the vascular situation and optimizing a patient's general condition is mandatory to achieve successful results.