Esophagectomy Procedure
Overview
Esophagectomy is a surgical resection that removes all or part of the esophagus, the tube that carries food from the mouth to the stomach. After the surgeon removes the damaged section, reconstruction typically uses a part of the stomach to rebuild the passage.
Surgeons often perform this thoracic surgery for advanced esophageal cancer and sometimes for conditions like Barrett esophagus, especially if they find abnormal cells. Other reasons for this procedure include severe achalasia, persistent strictures, or injury from harmful substances. The surgical team selects the technique based on the patient’s specific health needs.
| Common Reasons for Esophagectomy |
|---|
| Advanced esophageal cancer |
| Barrett esophagus with high-grade changes |
| End-stage achalasia |
| Severe strictures |
| Damage from swallowed substances |
Why the Procedure Is Performed
Doctors most often recommend surgery to remove all or part of the esophagus for serious health issues related to the esophagus. Below is an overview of the main reasons for this operation.
- Treatment for Esophageal Cancer:
Surgeons remove cancer from the esophagus more than for any other reason. There are several types of esophageal cancer that might require surgery, including:
| Type of Cancer | Details |
|---|---|
| Adenocarcinoma | Usually performs in the lower esophagus. |
| Squamous Cell Carcinoma | Typically located upper/mid esophagus. |
| Esophageal Carcinoma | General term for cancers in this area. |
- Managing Advanced Cases: If the cancer is advanced or causing blockage or pain, this surgery can help relieve symptoms even if curing the cancer is not possible.
- Other Conditions Treated: Besides cancer, doctors sometimes use this operation to treat severe swallowing problems, like achalasia, when other treatments have failed.
- Surgical Methods: Surgeons can use traditional open surgery or less invasive methods such as laparoscopy or robot-assisted techniques. Minimally invasive approaches can lead to less pain and faster healing for some patients.
Possible Risks
An esophagectomy can cause several complications. Common problems include pneumonia, bleeding, wound infection, and leakage where the surgeon joins the stomach to the esophagus.
Patients may also face pulmonary embolism, acid reflux, or strictures. Other possible effects are delayed gastric emptying, voice changes, and heart rhythm issues. In rare cases, these complications can increase the risk of death.
| Risk | Example/Impact |
|---|---|
| Leakage | Fluid leaks at surgical site |
| Infection | Wound or deeper tissue |
| Pneumonia | Breathing problems |
| Acid Reflux | Heartburn or chest discomfort |
| Blood Loss | May require transfusion |
How You Get Ready
Eating, Drinking, and Prescribed Drugs
Patients should check with their medical team about when to stop eating and drinking before the procedure. Usually, they need to stop food and drinks by midnight on the night before surgery.
The medical team should review medicines—especially blood thinners like aspirin or other anticoagulants—because some may need to be paused several days before the operation to lower bleeding risk.
Always bring an up-to-date list of all current medications. People will also need to talk to their doctor if they use regular over-the-counter drugs or supplements. If smoking is an issue, stopping as early as possible is key, since it helps reduce complications linked to anesthesia or lung problems.
What to Wear and Bring
When packing for a hospital stay, choose simple, loose-fitting clothing such as sweatpants, a soft shirt, or a robe. Bring personal care items—like a toothbrush, glasses, or hearing aids—to make the stay more comfortable.
| Essential items to consider |
|---|
| List of medications |
| Loose clothing or robe |
| Eyeglasses or hearing aids |
| Toothbrush or hairbrush |
| Advance directive |
| Books or music device |
Pack items for relaxation, such as a book or a music player with headphones. Always take along a copy of the advance directive, which tells the healthcare team what to do in case of emergency.
Extra steps to stay safe
The care team will want to know about any allergies to medicines or previous bad reactions to anesthesia. Those who meet with thoracic surgeons or the anesthesia team should ask any questions about surgery details, including if endoscopy will be involved or if an abdominal incision is planned.
Family or support persons should be included in planning for the hospital stay and for help at home after discharge. Surgeons and nurses will give instructions for medications and activity after returning home. Following these directions closely can help recovery go more smoothly.
What You Can Expect
Getting Ready for Surgery
Patients will undergo detailed testing before their esophagectomy to help decide the best type of surgery. Imaging tests like CT and PET scans show if cancer is present and how far it has spread. Doctors use endoscopy, where a thin tube with a camera examines the esophagus. During this procedure, doctors might take a biopsy, which is a small sample of tissue.
Doctors use what they learn from these tests to plan the surgery. The team discusses with the patient which surgical option, like minimally invasive esophagectomy or a more open approach, best suits their health needs. Meeting with a nutritionist is common, as nutrition will be important after the operation.
What Happens in the Operating Room
During the surgery, the surgeon removes part or all of the esophagus. The amount removed depends on where the problem is and the type of condition, such as cancer or severe dysphagia. Surgeons may also remove a part of the upper stomach and lymph nodes nearby. There are a few types of surgical techniques:
| Surgical Approach | Description |
|---|---|
| Open Esophagectomy | One or more large incisions made in the neck, chest, or belly (thoracotomy or laparotomy). |
| Minimally Invasive Surgery | Several small incisions used; may be robot-assisted, laparoscopic, or thoracoscopic. |
| Transthoracic Esophagectomy | Chest and belly incisions are made. |
| Transhiatal Esophagectomy | Incisions in the belly and neck only, not chest. |
| Three Incision Esophagectomy | Involves the neck, chest, and abdomen. |
In some operations, the surgeon joins the esophagus to the stomach through an esophagogastric anastomosis. Sometimes, the surgeon attaches part of the intestine instead, if needed.
The surgical team usually pulls the remaining stomach up through the diaphragm’s opening and connects it to what is left of the esophagus. This creates a new route for swallowing and digestion. Depending on the surgical approach, the procedure may involve tools and cameras inserted through the small cuts (laparoscopic surgery).
What Comes After Surgery
After the procedure, patients will likely start feeding through a tube placed into the abdomen. This feeding tube helps provide nutrition while the tissues heal and until the new connection in the digestive tract is strong.
As recovery progresses, eating by mouth will resume, but meals must be small and frequent because the stomach often holds less food. Some weight loss is common at this stage. Patients may need to watch for signs of problems such as trouble swallowing (dysphagia) or issues with gastric emptying.
The health team monitors closely during this period to ensure healing and to help manage any complications. Support and instructions on food choices, activity, and medications are provided to help the person recover as smoothly as possible.
Findings
People who have esophagectomy often notice their daily lives improve, though some discomfort may persist. Regular care after surgery focuses on several areas:
- Pulmonary Rehabilitation: Used to lower the chance of breathing troubles.
- Pain Control: Aimed at easing heartburn and helping with swallowing.
- Nutritional Support: Checks for weight loss and helps improve nutrition.
- Emotional Support: Offered if any psychological issues develop.
Chemotherapy may also be part of post-surgery treatment plans depending on each case.
