The ipsilateral mediastinal pleura, which remains in contact with the esophagus, is incised through the anterior thoracic incision. The arch of the azygos vein is incised, enabling the dissection of the cervicothoracic esophagus. To expand the mediastinal lymphadenectomy, this incision is used to dissect the intercostal veins. The trunk of the azygos vein is ligated at the supradiaphragmatic level and associated thoracic duct excision is required by the lymphatic involvement.
During esophageal dissection at the high level of the cervical region, a tracheobronchial intubation with a Carlens tube can be used to facilitate access to the esophagus, occluding the right bronchial tube (see Chapter "Abdominothoracic Esophagectomy" STEP 1-3).
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