Center for Minimally Invasive Esophageal Therapies
The Center for Minimally Invasive Esophageal Therapies at the Boston Medical Center is dedicated to the diagnosis and treatment of tumors of the esophagus and chest. We take a multidisciplinary approach to your care, offering you the most effective treatments, including esophagectomy. We know that a cancer diagnosis creates uncertainty for you and your family. That's why in addition to our medical expertise, we provide compassionate care that focuses on giving you the best experience possible.
Esophageal cancer is the uncontrolled growth of abnormal cells in the esophagus. The esophagus is a flexible tube connecting the throat to the stomach between 10 and 13 inches long. The esophagus contracts when you swallow to push food down into the stomach and mucus helps move this process along.
Esophagectomy is the surgical removal of the esophagus. Esophagectomy typically is recommended when the cancer has not spread to other parts of your body, and is potentially curable.
In esophagectomy, most of your esophagus and nearby lymph nodes are removed. Your stomach is then moved up and attached to the remaining portion of your esophagus. There are several techniques for performing esophagectomy. Your surgeon will consider several factors such as your overall condition, the size and location of the tumor, and the involvement of the tissue and organs near the tumor.
Common approaches to esophagectomy are:
- Transhiatal, in which your surgeon gains access to your esophagus through incisions in your abdomen and neck
- Transthoracic, in which your surgeon gains access to your esophagus through incisions in your abdomen and the right or left side of your chest
- Thoracoabdominal, in which your surgeon gains access to your esophagus through one long incision from your chest to your abdomen
- Minimally invasive, in which your surgeon gains access to your esophagus using a series of small band-aid sized incisions, and performs the procedure with specially made surgical tools that are inserted through the incisions
How to Prepare
Before your surgery, you will meet with your surgeon. At that time, your surgeon will review the results of tests and diagnostic procedures that have been done up to that point, ask you about your medical history and perform a physical examination. The surgeon will discuss his or her findings and recommendations.
Please tell your doctor if you have any allergies to medication or have had problems with anesthesia. Your surgeon will give you any specific instructions about dietary or activity restrictions and will instruct you about whether you should take your regular medications on the day of the procedure. You will also be asked to not eat or drink after midnight on the night before your procedure.
What to Expect
In some cases, you will be admitted to the hospital the day before your surgery. This is so antibiotics can be given and so bowel preparation can be completed. Bowel preparation involves drinking a solution that will empty your bowel before the surgery. Esophagectomy is performed under general anesthesia and is a complex, time-consuming procedure. What happens once the procedure begins depends on the approach your surgeon takes:
- Transhiatal. During a transhiatal approach, your surgeon will make incisions in your abdomen and your neck. Once he or she gains access to your esophagus and stomach with the abdominal incision, he or she will separate your stomach and esophagus from nearby structures and remove nearby lymph nodes. After making the incision in your neck, your surgeon will separate the upper part of your esophagus from nearby structures and remove it. He or she will then make a tube from the top part of your stomach, and attach it to the remaining part of your esophagus.
- Transthoracic. After making an incision in your abdomen, your surgeon will remove the upper part of your stomach—as well as the lower and middle parts of your esophagus and nearby lymph nodes—through this incision. He or she will make an incision in the left or right side of your chest and remove the remaining part of your esophagus. Your surgeon will make a tube from your stomach, and attach it to the remaining part of your esophagus. Your stomach and esophagus may be reattached either in your chest or through a third incision or in your neck.
- Thoracoabdominal. Your surgeon will make one long incision that extends down your chest and into your abdomen. He or she will remove your esophagus and part of your stomach, and reconnect them in your neck or the chest.
- Minimally invasive. Your surgeon will make a series of small incisions, and insert tube-like instruments, including a video camera, through them. He or she will remove the upper part of your stomach, most of your esophagus, pull your stomach up, and connect it with the remaining part of your esophagus. The remaining esophagus and stomach will be connected either in the chest cavity or the neck.
Whichever approach is used, your physician will leave a small feeding tube that can be used to provide nutrition while your esophagus heals. This is not a permanent tube, and the process of removal is not difficult or painful.
Depending on the approach your surgeon takes, esophagectomy takes approximately 5 to 10 hours to complete.
Following your surgery, you will be transferred to the Post Anesthesia Unit. This is a recovery area near the operating room where you will be connected to several monitoring devices. Members of the team will watch your condition closely as you awaken from anesthesia. When you have recovered sufficiently, you will be transferred to a bed in the intensive care unit. Nurses in these units are specialists in caring for patients who have had esophageal surgery.
Before you go home, your physician or nurse will teach you how to care for your incision. Gradually, over the course of a few weeks, you will regain your strength and be able to return to work and participate in physical activity. Be sure to call your doctor if you notice any of the following:
- High temperature
- Allergic reaction, such as redness, swelling, trouble breathing
Always take your medicine exactly as prescribed. Call us if you have any questions or changes.