**2.4. Optimal surgical approach**

Tumor location as well as surgeon experience often dictates the type of surgery performed. Multiple accepted operative approaches to esophageal carcinoma include Ivor Lewis esophagogastrectomy, McKeown esophagogastrectomy, transhiatal esophagogastrectomy, and left transthoracic or thoracoabdominal approaches. Minimally invasive techniques include laparoscopic and robotic esophagectomies. While minimally invasive esophagectomies have been shown to be safe and effective with equivalent oncologic outcomes, robotic, rather than laparoscopic approaches are becoming common [42–44]. However, one should be aware that there is a learning curve when a surgeon is transitioning to minimally invasive esophagectomies [45]. Transthoracic esophagectomies include the Ivor Lewis esophagogastrectomy and the McKeown esophagogastrectomy. Morbidity varies on the location of the anastomosis and if the transthoracic approach was used. While the transthoracic approach may have an increased morbidity, it does allow for extended lymphadenectomies to be performed, possibly increasing long-term survival [10, 46] .
