Oesophagectomy

Oesophagectomy is the surgery to remove your food pipe. It is usually done for patients with esophageal cancer and is done when esophageal cancer is detected, before it has spread to other parts of the body.

Some Facts about Oesophagectomy:

• Osophagus is a part of the gastrointestinal tract which is a muscular tube, that allows food to travel from your mouth to your stomach.
• The diseased part of the oesophagus will be removed in an Oesophagectomy, which may involve either removing all or part of your oesophagus, or somet part of the stomach along with it, depending on the size and location of the diseased section
• This surgery is performed if you have an ulcer or growth because o cancer which needs to be removed.
• Surgical removal of the Osophagus is the only way of curing oesophageal cancer, which is often used in addition to other treatments such as chemotherapy or radiotherapy.
• It is known as 'neo-adjuvant chemotherapy' if a course of chemotherapy is required along with Oesophagectomy to reduce the size of the cancer.
• It is known as 'adjuvant chemotherapy' when the patient go on to have further chemotherapy after surgery to ensure that there are no remaining cancer cells.
• Esophagectomy is also performed for benign disease such as esophageal atresia in children, achalasia, or caustic injury.

Types of Oesophagectomy:

• Transhiatal esophagectomy (THE) and Transthoracic esophagectomy (TTE) are  two main types of esophagectomy.
• The type of Oesophagectomy depends on the stage and position of your cancer.
• The part of the oesophagus containing the cancer will be removed by your surgeon in an oesophagectomy.
• It is called as a total oesophagectomy when your surgeon removes your whole oesophagus.
• The top of your stomach and the part of the oesophagus containing cancer will be removed by your surgeon in an oesophago-gastrectomy.
• Some of the nearby lymph nodes will be removed be removed by your surgeon in a lymphadenectomy or lymph node dissection which helps to reduce the risk of cancer coming back.
• The type of Oesophagectomy you need for cancer of the oesophagus depends on the size of your cancer and the location of the cancer in your oesophagus
• A transhiatal esophagectomy (THE) is performed on the neck and abdomen simultaneously where as A transthoracic esophagectomy (TTE) involves opening the thorax (chest).

Preparation for Oesophagectomy:

• You will be admitted to the hospital the day before your surgery and will be monitored by a member of the surgical team.
• You are not allowed to eat or drink anything for between 4 to 6 hours before surgery.
• An anaesthetist will give you a general anaesthetic before the surgery so that you will be asleep during the operation.
• Anti-embolic stockings will be applied to help reduce the risk of a DVT or blood clots in the legs.
• You may also be given a small injection, just under the skin in your stomach to help prevent a blood clot.

Procedure for Oesophagectomy:

• Usually Oesophagectomy is performed by 'keyhole' surgery, which requires a number of small cuts in the stomach and the right hand side of the chest, and a cut in the neck.
• There may be two larger cuts, one down the middle of your stomach and the other either on your chest or above the collarbone if keyhole surgery cannot be performed.
• All three cuts are required in some people.
• The surgical approach that is most likely to be used will be discussed by your surgeon.
• It can take between 4 and 8 hours to perform oesophagectomy as it is a very complex operation.
• A thin, flexible tube with a light and a camera is used to look inside and operate on your body. A thoracoscope is used to look inside and operate on your chest and a laparoscope is used to look inside and operate on your tummy  .
• The laparoscope is connected to a fibre optic camera which shows pictures of the inside of the body on a video screen.
• The other incisions are used by the surgeon to put the other instruments they use to do the surgery into your body.
• The surgeon frees the stomach using the laparoscope and other instruments so that they can move it into the chest.
• The keyhole surgery to your chest or an open operation can be performed to remove the cancer and join the remaining stomach to the remaining oesophagus.
• Most of your oesophagus and a small part of your stomach will be removed, along with the lymph glands during the surgery.
• The remainder of the stomach is made into a tube which will be joined to the remainder of the oesophagus, either in the chest or high in the neck, through the neck wound.
• The removed portion will be sent or a biopsy to help decide whether you will require any further treatment.
• You may have a scar on your abdomen or chest scar, on the right or left which goes round towards your back underneath the shoulder blade or a neck scar depending on the type of operation you have. You could have a combination of these scar also.
• Laparoscopic surgery usually takes between 5 to 7 hours which is longer than the conventional open surgery.

Recovery from Oesophagectomy:

• The rates of recovery from Oesophagectomy vary from person to person, and are dependent on several factors.
• It may take around 10 days to two weeks to stay in hospital after Oesophagectomy
• The length of stay in hospital may increase when the patient develop a complication.
• Your risk of developing a complication  may include chest infections and other respiratory (lung) problems, wound infections, anastomotic leak (delayed healing of the new 'join' between oesophagus and stomach), heart problems, deep vein thrombosis (blood clot in the veins of the leg) and damage to the nerves of the voice box.