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 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 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 the surgeon gains access to the esophagus through incisions in the abdomen and neck
- Transthoracic, in which the surgeon gains access to your esophagus through incisions in the abdomen and the right or left side of the chest
- Thoracoabdominal, in which the surgeon gains access to your esophagus through one long incision from the chest to the abdomen
- Minimally invasive, in which the surgeon gains access to the 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 for Esophagectomy
Prior to surgery, the patient will meet with their surgeon. At that time, the surgeon will review the results of all tests and diagnostic procedures that have been done up to that point, ask about medical history, and perform a physical examination. The surgeon will discuss his or her findings and recommendations.
Patients should tell their doctor about any allergies to medication or problems with anesthesia. The surgeon will give specific instructions about dietary or activity restrictions, and he or she will instruct whether to take one’s regular medications on the day of the procedure.
Patients will also be asked to not eat or drink after midnight on the night before their procedure.
What to Expect During Esophagectomy
In some cases, the patient will be admitted to the hospital the day before surgery. This is so antibiotics can be given and bowel preparation can be completed. Bowel preparation involves drinking a solution that will empty the bowel before surgery. Esophagectomy is performed under general anesthesia and is a complex, time-consuming procedure. What happens once the procedure begins depends on the surgical approach:
- Transhiatal. The surgeon makes incisions in the abdomen and neck. Once he or she gains access to the esophagus and stomach with the abdominal incision, he or she will separate the stomach and esophagus from nearby structures and remove nearby lymph nodes. After making the neck incision, the surgeon separates the upper part of the esophagus from nearby structures and remove it, and then makes a tube from the top part of the stomach, and attaches it to the remaining part of the esophagus.
- Transthoracic. After making an incision in the abdomen, the surgeon removes the upper part of the stomach, as well as the lower and middle parts of the esophagus and nearby lymph nodes through this incision. He or she makes an incision in the left or right side of the chest and removes the remaining part of the esophagus. The surgeon will make a tube from the stomach, and attach it to the remaining part of the esophagus. The stomach and esophagus may be reattached either in the chest or through a third incision in the neck.
- Thoracoabdominal. The surgeon makes one long incision down the chest and into the abdomen. He or she then removes the esophagus and part of the stomach, and reconnects them in the neck or the chest.
- Minimally invasive. The surgeon makes a series of small incisions, and inserts tube-like instruments, including a video camera, through them. He or she will remove the upper part of the stomach, most of the esophagus, pulls the stomach up, and connects it with the remaining part of the esophagus. The remaining esophagus and stomach are connected either in the chest cavity or the neck.
Whichever approach is used, the physician will leave a small feeding tube that can be used to provide nutrition while the esophagus heals. This is not a permanent tube, and removing it is not difficult or painful.
Depending on the surgical approach, esophagectomy takes approximately 5 to 10 hours to complete.
Recovery after an Esophagectomy
Following surgery, patients are transferred to a recovery area near the operating room where they will be connected to several monitoring devices. Members of the team will watch the patient as they awaken. When ready, patients are transferred to a bed in the intensive care unit. Nurses in these units are specialists in caring for patients who have had esophageal surgery.
Prior to discharge, the patient is instructed how to care for their incision. Gradually, over the course of a few weeks, they regain their strength and are able to return to work and participate in physical activity.
Patients should call their doctor if they notice any of the following:
- Bleeding
- Infection
- High temperature
- Allergic reaction, such as redness, swelling, trouble breathing
- Pain
Patients should always take their medicine exactly as prescribed and call the doctor if they have any questions or changes.