Esophagectomy includes removal of much of the esophagus (tube that extends from the back of the throat to the stomach) and nearby lymph nodes. During surgery, a new pathway is made so that food and fluids can travel from your mouth to your stomach. This is done by connecting the upper end of the stomach to the remaining portion of the esophagus. Your surgeon can use one of three methods for the esophagectomy:
Minimally invasive: This method includes small incisions in the chest and abdomen, and the use of 2 scopes: a thoracoscope (to view and operate in the chest) and a laporascope (to view and operate in the abdomen).
Transhiatal: Incisions are made in the neck and abdomen. No incision is made in the chest.
Thoracotomy: An incision is made on the side of the chest between the ribs. Another incision is made in the abdomen. Based on your condition, your surgeon will describe the best option for you.
Why an Esophagectomy?
The most common reason for undergoing an esophagectomy is for the treatment of esophageal cancer. But esophagectomy may also be performed to treat:
- Achalasia (where the esophagus doesn’t function properly).
- Pre-cancerous, high-grade dysplasia such as Barrett’s esophagus.
- Severe trauma to the esophagus.
Risks of Esophagectomy
As with any surgery, there are risks inherent, and you should discuss them with your doctor. Some conditions may increase the risk of complications from esophagectomy, including:
- Older than 60 years of age.
- Heavy smoker.
- Steroid medications.
- Poor physical condition.
- Weight loss from cancer.
Some risks inherent to esophagectomy include:
- Acid reflux.
- Injury to vital organs during surgery.
- Leakage of contents of esophagus or stomach at the point where the surgeon joins the two.
Your doctor will have you undergo a complete physical examination prior to surgery, and determine whether there are any conditions that might cause complications during surgery, such as:
- High blood pressure.
- Cardiopulmonary problems.
Your doctor may ask you to stop taking any drugs that inhibit blood clotting, as well as to quit smoking if you are a smoker.
Once you arrive in the operating room, general anesthesia is given. It begins with IV medicine and includes breathing anesthetic gases mixed with oxygen. You will not be aware of the surgery or your surroundings. A breathing tube is placed into your windpipe to help you breathe during surgery. This is why some patients have a slight sore throat for a day after surgery. A tube is also placed in your bladder to drain urine.
The surgeon will then remove most of the esophagus. The remaining portion of the esophagus will be connected to the stomach. The area where the esophagus and stomach are connected is called the anastamosis. It can be either in the upper part of the chest or in the neck.
The removed portion of esophagus (including tumor, if present, and lymph nodes) will be sent to the lab and examined.
A nasogastric (NG) tube will then be placed into your nose down the repaired esophagus and into your stomach. The NG tube will keep your stomach empty until the repaired area heals. Your surgeon will also insert a small tube through your abdomen and into your small intestine (jejunum). This tube, called a J-tube, will provide needed nutrients until you are able to eat.
If you had a thoracotomy, a tube will be inserted into the chest and is connected to a container. The tube drains air and fluid from the chest.
While in the hospital you will not be allowed to eat for the first 5 to 7 days after surgery to allow for healing where the stomach is connected to the esophagus. After allowing time for healing your surgeon will test to be sure there is no leak at the anastomosis. If that test goes well, you will be started on a liquid diet.
Eating will be different after surgery mainly because the stomach is now stretched up into the chest and cannot hold as much food at one time as it used to. Therefore when you start to eat, you will feel full very quickly and will need to eat 6 small meals each day instead of 3 normal ones.
You may also find that you have difficulty (stomach upset) with some foods. These are different for each person but common problem foods include coffee, chocolate and anything with high concentrations of sugar.
You will leave the hospital with the J-tube (feeding tube) in your abdomen. This may be used to supplement your food intake as some patients have difficulty eating enough initially after surgery. It will be removed in the office after your weight has stabilized. Before you leave the hospital you will be shown how to care for the tube. You will remain on a soft diet when you go home from the hospital. Your surgeon will tell you when you can resume a regular diet. Usually, this is after the first visit to the surgeon’s office.
Begin your regular diet with small portions.
Most patients resume their usual routine within 4 to 6 weeks after surgery. Talk with your doctor about returning to work. This depends on your work and its demands.