Esophagectomy

Esophagectomy is a surgical procedure to remove some or all of the esophagus and then reconstruct it using part of another organ.

Some Facts about Esophagectomy:

• Esophagectomy is a common surgical treatment for esophageal cancer.
• It is occasionally used for Barrett's esophagus if aggressive precancerous cells are present.
• An esophagectomy may also be done for noncancerous conditions in order to attempt saving the esophagus with end stage achalasia or strictures, or after ingestion of material that damages the lining of the esophagus.
• Esophagectomy is done either to remove the cancer in esophagus or to relieve its symptoms.
• All or part of the esophagus will be removed through an incision in the neck, chest or abdomen by the surgeon during an open esophagectomy. The esophagus will be replaced using another organ o the body, most commonly the stomach. But, occasionally the small or large intestine can also be used.
• Esophagectomy can be done with minimally invasive surgery, either by laparoscopy, robot assisted or a combination of these approaches in most o the cases which are done through several small incisions.
• Laparoscopy will have educed pain and faster recovery than conventional open surgery.
• Bleeding, Infection, Cough, Leakage from the surgical connection of the esophagus and stomach, Changes in your voice, Acid or bile reflux, Nausea, vomiting or diarrhea, Respiratory complications, such as pneumonia, Swallowing difficulties (dysphagia), Atrial fibrillation and Death are some of the common risk of Esophagectomy.

Preparation of Esophagectomy:

• Chemotherapy or radiation or both, followed by a period of recovery may be recommended by your doctor before an esophagectomy if you have cancer and the cancer has spread to the lymph nodes.
• The decision of any kind o treatment will be made based on the stage of your tumor.
• You will asked to quit smoking and a cessation program may be recommended to help you quit, as your risk of complications will greatly increased by smoking after surgery.
• You need to discuss about your regular medications with your doctor whether you can take them before your surgery.
• Some of them such as blood thinners need to be stopped a few days in advance of the planned surgery.
• The preparation for surgical procedure may include taking a clear liquid diet one or two days before surgery, not eating on the day of surgery and taking a medication to cleanse your bowels the day before surgery.
• Talk to your doctor about any allergies or reactions you have had to medications.
• Several test including computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging, as well as endoscopy with biopsies, and endoscopic ultrasound-guided fine-needle biopsies during endoscopy will be done to determine which type of procedure is best for you.

Procedure or Esophagectomy:

• Some or most of the esophagus will be removed during an Esophagectomy.
• A portion of the top of the stomach and nearby lymph nodes will also be removed if cancer is involved.
• The amount of esophagus and stomach that has to be removed depends on the stage of the cancer and its location.
• A portion of the intestine  may be pulled up rather than the stomach and connected to the esophagus in some cases.
• One or more large incisions in the neck, chest or abdomen will be made by the surgeon during an open surgery.
• It is called a transhiatal esophagectomy if the main incisions are in the neck and abdomen.
• It is called a transthoracic esophagectomy if the main incisions are in the chest and abdomen.
• The esophagus will be removed through incisions in the abdomen and chest during a transthoracic esophagectomy or a transhiatal esophagectomy will be performed, in which the incisions are done in the abdomen and neck.
• A three field esophagectomy will be done occasionally, in which a neck, chest and abdominal incision is needed.
• The esophagus can also be removed through several small incisions in the abdomen laparoscopically or the chest thoracoscopically with the help of minimally invasive esophagectomy.
• An instruments and a camera tipped device will be inserted through the incisions by the surgeon to view and perform the operation without dividing the muscles or breaking a rib. This procedure may be robot assisted in some centers.
• Surgery will be done using an endoscope passed down your throat and into your esophagus to remove  the cancer and margin of healthy tissue that surrounds it, if our cancer is very small, confined to the superficial layers of your esophagus and has not spread.
• The portion of your esophagus that contains the cancer, along with a portion of the upper part of your stomach, and nearby lymph nodes will be removed during esophagectomy. The remaining part of esophagus is reconnected to your stomach by pulling the stomach up to meet the remaining esophagus.
• A part of your esophagus, nearby lymph nodes and a larger part of your stomach will be removed during esophagogastrectomy. The remainder of your stomach is then pulled up and reattached to your esophagus. Some part of your colon will be used to help join the two if necessary.

Recovery from Esophagectomy:

• A tube feeding will be recommended by your doctor after the surgery which will continue for four to six weeks to ensure adequate nutrition while you recover.
• You will need to eat more frequent, smaller quantities once you resume a normal diet as the size o your stomach has reduced.
• Comprehensive follow-up care will be recommended by your doctor to prevent complications after surgery and to help you adjust your lifestyle which include lung therapy or pulmonary rehabilitation to prevent breathing problems, pain management to treat heartburn and problems with swallowing. nutritional assessments to help with weight loss and psychosocial care if needed.