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Volume 16
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10.3390/jpm16060291
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Review

Anatomical Variations in Critical Structures in Esophageal Surgery: Implications for Personalized Surgery

by
George Triantafyllou
1,
Adam Mylonakis
2,
Nikoletta Dimitriou
2,
Chrysovalantis Vergadis
3,
Orestis Lyros
4,
George Tsakotos
1,
Maria Piagkou
1 and
Dimitrios Schizas
2,*
1
Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
2
First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
3
Third Department of Radiology, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
4
Fourth Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2026, 16(6), 291; https://doi.org/10.3390/jpm16060291
Submission received: 13 February 2026 / Revised: 12 May 2026 / Accepted: 25 May 2026 / Published: 27 May 2026
(This article belongs to the Special Issue Personalized Management of Abdominal Surgery and Complications)
Versions Notes

Abstract

Esophageal cancer remains a global challenge, with poor overall survival despite advances in multimodal therapy. Surgical resection continues to be the main curative treatment, yet esophagectomy is among the most technically challenging oncological procedures due to the esophagus’s location within the densely packed mediastinal corridor. Critical vascular, neural, and lymphatic structures surround the esophagus, and their frequent anatomical variations pose significant risks during mobilization, lymphadenectomy, and reconstruction. This review synthesizes current evidence on the anatomical variability in the vessels, nerves, lymphatics, and fascial compartments relevant to esophageal surgery. Particular emphasis is placed on aberrant arterial and venous patterns, recurrent and non-recurrent laryngeal nerve pathways, thoracic duct variants and atypical courses, and the fascial planes that are used to define surgical boundaries. By shifting the surgical paradigm from standardized anatomical assumptions to patient-specific structural mapping, we highlight how understanding these variations is driving the field of personalized surgical medicine. By integrating these anatomical insights with surgical approaches—including right and left transthoracic, transhiatal, and transcervical techniques—we highlight the implications of variations for intraoperative safety and postoperative outcomes. A thorough understanding of these relationships is essential for surgical planning, minimizing morbidity, and achieving oncological outcomes. Ultimately, a thorough understanding of these relationships is essential for patient-tailored surgical planning.
Keywords: anatomical variation; esophageal surgery; thoracic surgery; aberrant subclavian artery; recurrent laryngeal nerve; thoracic duct; precision surgery; patient-tailored planning; surgical anatomy anatomical variation; esophageal surgery; thoracic surgery; aberrant subclavian artery; recurrent laryngeal nerve; thoracic duct; precision surgery; patient-tailored planning; surgical anatomy

Share and Cite

MDPI and ACS Style

Triantafyllou, G.; Mylonakis, A.; Dimitriou, N.; Vergadis, C.; Lyros, O.; Tsakotos, G.; Piagkou, M.; Schizas, D. Anatomical Variations in Critical Structures in Esophageal Surgery: Implications for Personalized Surgery. J. Pers. Med. 2026, 16, 291. https://doi.org/10.3390/jpm16060291

AMA Style

Triantafyllou G, Mylonakis A, Dimitriou N, Vergadis C, Lyros O, Tsakotos G, Piagkou M, Schizas D. Anatomical Variations in Critical Structures in Esophageal Surgery: Implications for Personalized Surgery. Journal of Personalized Medicine. 2026; 16(6):291. https://doi.org/10.3390/jpm16060291

Chicago/Turabian Style

Triantafyllou, George, Adam Mylonakis, Nikoletta Dimitriou, Chrysovalantis Vergadis, Orestis Lyros, George Tsakotos, Maria Piagkou, and Dimitrios Schizas. 2026. "Anatomical Variations in Critical Structures in Esophageal Surgery: Implications for Personalized Surgery" Journal of Personalized Medicine 16, no. 6: 291. https://doi.org/10.3390/jpm16060291

APA Style

Triantafyllou, G., Mylonakis, A., Dimitriou, N., Vergadis, C., Lyros, O., Tsakotos, G., Piagkou, M., & Schizas, D. (2026). Anatomical Variations in Critical Structures in Esophageal Surgery: Implications for Personalized Surgery. Journal of Personalized Medicine, 16(6), 291. https://doi.org/10.3390/jpm16060291

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