Key Points

• A successful transhiatal esophagectomy involves an orderly series of steps: the abdominal, cervical, mediastinal, and cervical esophagogastric anastomotic phases of the operation.
• A surgeon’s assessment of esophageal mobility on manual palpation through the diaphragmatic hiatus is the most important determinant of the appropriateness of a transhiatal esophagectomy.
• A surgeon performing a transhiatal esophagectomy is not absolved of the responsibility of having a firm knowledge of thoracic anatomy and the complications of esophagectomy and their management.
• A properly mobilized stomach should be as pink in the neck prior to the esophagogastric anastomosis as it was in the abdomen when the operation began.
• A cervical esophagogastric anastomotic leak translates to a stricture in 50% of cases; a meticulous side-to-side stapled anastomosis minimizes the risk of this complication and the need for life long dilations.