iii. Transhiatal esophagectomy
The stomach is mobilised through a midline abdominal incision and the cervical esophagus is mobilised through an incision in the neck.The diaphragm is then opened from the abdomen and the posterior mediastinum is entered.The lower esophagus and the tumor are mobilished under direct vision, and the upper esophagus is mobilished under blunt dissection.This approach can provide the adequate removal of the tumor and lymph nodes in the lower mediastinum, but it is not possible to remove the nodes in the middle and upper mediastinum.
It may be a useful procedure for the lower esophagus, but is hazardous for a middle-third lesion that may be adherent to the bronchus or to the azygos vein.