CPT® Code 43118

Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

The procedure described by CPT® Code 43118 is a complex surgical intervention known as a partial esophagectomy, specifically targeting the distal two-thirds of the esophagus. This procedure is performed through a thoracotomy, which involves making an incision in the chest, and a separate abdominal incision, allowing access to both the thoracic and abdominal cavities. The surgery may be conducted with or without a proximal gastrectomy, which is the partial removal of the stomach. A key aspect of this procedure is the reconstruction of the esophagus, which can be achieved using either a segment of the colon or small intestine. This involves mobilizing and preparing the chosen segment of intestine, followed by creating an anastomosis, or surgical connection, to either the pharynx or the remaining portion of the esophagus. The surgical approach typically includes a right posterior thoracotomy, where the skin is incised, and the incision is extended through the soft tissues to access the thoracic cavity. The procedure requires careful dissection to expose the esophagus while preserving critical structures such as the pneumogastric and recurrent nerves, as well as the azygous vein and bronchial artery. The esophagus is meticulously freed from surrounding tissues, and a separate incision in the abdomen allows for exploration of the peritoneal cavity and mobilization of the stomach. The esophagus is then transected near the esophagogastric junction, and if necessary, a portion of the stomach may also be excised to ensure complete removal of any malignancy. The choice of using a section of colon or small intestine for reconstruction depends on various factors, including the extent of the disease and the specific anatomy of the patient. The procedure is intricate, requiring precise measurements and careful handling of vascular structures to ensure adequate blood supply to the graft. Following the anastomosis, a jejunostomy tube is placed to facilitate feeding and decompression, highlighting the complexity and the need for meticulous surgical technique in this procedure.