Esophagectomy

Esophagectomy is a surgical procedure in which all or part of the esophagus and nearby lymph nodes are removed. Afterwards, your stomach is moved up and attached to the remaining portion of your esophagus. This creates a new esophagus. It is most often performed for esophageal cancer.

Esophagectomy can be performed using the following methods: Minimally-Invasive (small incisions of 2–3 inches long / general anesthesia), or open-surgery (large incisions of 8-10 inches long / general anesthesia). The type of method will vary according based on your condition.

How to Prepare for Esophagectomy Procedure

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before Eophagectomy Procedure

To determine whether you need this procedure, your doctor might perform a variety of diagnostic tests, including:

• Upper endoscopy with tissue biopsy
• Endoscopic ultrasound
• Computed tomography (CT scan)
• Positon-Emission tomography (PET)

What to Expect During Eophagectomy Procedure

Minimally Invasive Approach

Open Approach

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An esophagectomy will typically take between 3 to 6 hours to complete. This procedure is typically performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general, during a minimally-invasive esophagectomy:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Usually, your doctor will administer general anesthesia (make you feel sleepy).
• Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• The doctor makes 3 to 4 small incisions in your upper belly, chest, or lower neck and proceed to insert a camera for guidance.
• The camera allows the doctor to view the area being operated on. Other surgical tools are inserted through the other cuts.
• The doctor frees the esophagus from nearby tissues. Depending on how much of your esophagus is diseased, part or most of it is removed.
• If part of your esophagus is removed, the remaining ends are joined together using staples or stitches. If most of your esophagus is removed, the doctor reshapes your stomach into a tube to make a new esophagus. It is joined to the remaining part of the esophagus.
• During surgery, lymph nodes in your chest and belly are likely removed if cancer has spread to them.
• A feeding tube is placed in your small intestine so that you can be fed while you are recovering from surgery.
• Once the overall procedure is complete, you incision(s) will be closed off with the use of stiches or staples, and you will be moved to the recovery area.

What to Expect After Eophagectomy Procedure

After the surgery, you will be taken to the intensive care unit (ICU) and stay in the hospital for 7 to 14 days. Other recommendations include:

General Guidelines

• Your recovery process will vary depending on the type of procedure done. The incision sites will be checked often.
• The breathing tube is removed when you wake up from anesthesia.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after tests are done to ensure that connection between the remaining esophagus and the “new” esophagus made from the stomach is intact.
• A liquid diet may be started.
• You can probably do your normal activities after the surgery. But, you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.
• Your doctor will give you instructions to follow during your recovery.