Esophagectomy is a surgical procedure to remove part of the tube between your mouth and stomach (esophagus) and then reconstruct it using some or all of another organ, usually the stomach. Esophagectomy is a common treatment for advanced esophageal cancer, and is used occasionally for Barrett's esophagus if aggressive precancerous cells are present.
Why it's done
Esophagectomy is the main surgical treatment for esophageal cancer. It is done either to remove the cancer or to relieve symptoms.
During an esophagectomy, the surgeon removes all or part of the esophagus through an incision in the chest or abdomen or both. The esophagus is replaced using another organ, most commonly the stomach but occasionally the large intestine.
In some circumstances, esophagectomies can be done with minimally invasive surgery, either by laparoscopy or assisted with a robot. When the individual situation is appropriate, these procedures are done through several small incisions and can result in reduced pain and faster recovery than conventional surgery.
Esophagectomy carries a risk of complications, which may include:
- Leakage from the surgical connection of the esophagus and stomach
- Acid or bile reflux
- Respiratory complications, such as pneumonia
- Swallowing difficulties (dysphagia)
How you prepare
Before an esophagectomy, your doctor and treatment team will explain to you what to expect before, during and after the surgery as well as the potential risks of the surgery.
Your doctor and team will discuss concerns you may have about your surgery. If you smoke, your doctor will ask you to quit and may recommend a cessation program to help you quit, as smoking greatly increases your risk of complications after surgery.
Before being admitted to the hospital for your surgery, talk to your family about your hospital stay and discuss help you may need when you return home. Your doctor and treatment team may give you specific instructions to follow during your recovery when you return home.
Food and medications
Talk to your doctor about:
- When you can take your regular medications and whether you can take them before your surgery
- When you should stop eating or drinking the night before the surgery
Clothing and personal items
Your treatment team may recommend that you bring several items to the hospital including:
- A list of your medications
- Personal care items, such as a brush, eyeglasses or hearing aids
- Loosefitting, comfortable clothing
- A copy of your advance directive
- Items that may help you relax, such as portable music players or books
Talk to your doctor about:
- Any medications you have brought to the hospital and when you should take medications on the day of the procedure
- Allergies or reactions you have had to medications
What you can expect
An important aspect of esophagectomy is determining which type of procedure is best for you. To guide that decision, specialists use state-of-the-art imaging techniques, such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), as well as endoscopic ultrasound and fine-needle biopsies during endoscopy.
Before the procedure
A preoperative medical exam will be performed to look for conditions that could complicate surgery.
Your doctor may recommend chemotherapy or radiation or both, followed by a period of recovery, before an esophagectomy.
After the procedure
Your doctor will likely recommend tube feeding (enteral nutrition) for four to six weeks to ensure adequate nutrition while you recover. Once you resume a normal diet, the stomach's reduced size means you will need to eat more frequent, smaller quantities. You may lose weight after surgery.
Most people report improved quality of life after esophagectomy, but some symptoms usually continue. Your doctor will likely recommend comprehensive follow-up care to prevent complications after surgery and to help you adjust your lifestyle.
Follow-up care includes:
- Lung therapy (pulmonary rehabilitation) to prevent breathing problems
- Pain management to treat heartburn and problems with swallowing
- Nutritional assessments to help with weight loss
- Psychosocial care if needed