Esophagectomy is a surgical procedure. It is undertaken to remove part or whole of the esophagus, a tube that connects the mouth and stomach. It is generally referred to as a food pipe. This procedure removes the deceased from the damaged part of it and then reconstructs it using different tissue from the body, such as the stomach. This procedure is mainly used to treat
- advanced esophageal cancer
- Barrett's esophagus (which can lead to cancer)
- End-stage achalasia with strictures.
Alternate Name
- transhiatal esophagectomy.
- Ivor Lewis esophagectomy.
Body Location
Behind the trachea in the thorax
How is Esophagectomy Performed
This procedure involves removing a portion, or the whole esophagus, including part of the stomach and nearby lymph nodes, depending on the severity of the condition. It also depends on the stage of esophageal cancer and where it is located.
Depending on your situation, the surgeon will choose one of the following types of esophagectomy.
In an open esophagectomy, a large incision is made in the chest area, and the esophagus is removed from the neck, chest, or abdomen area, depending on the location of cancer or the disorder. The exact location of the incision is also the area of cancer. Once the esophagus is taken out, the surgeon then reconnects the remaining esophagus to the stomach, which is pulled up into the chest or neck area (depending on the type of esophagectomy).
In Robotic few small incisions are made in the chest or abdomen. During laparoscopy, the surgeon inserts instruments, and a device with a camera through the incisions and the resected esophagus is removed through the incision.
Preparation
Before the surgery, the doctors will use various imaging techniques, such as computerized tomography (CT), magnetic resonance imaging (MRI) as well as endoscopy with biopsies, and fine-needle biopsies, to determine which type of surgery is best suited for your condition.
The doctor will then discuss all your concerns about the surgery and all the medications and treatments you have taken before the surgery, including allergies.
You will be asked about your lifestyle habits such as smoking, diet, alcohol consumption, etc. You will be asked to stop having food or drink before the surgery to prevent aspiration. Sometimes you will be asked to be only on liquid for a day or two before the surgery. This surgery will be conducted on an empty stomach.
Right before the surgery, you will be taken to the operation room. Doctors will then give you anesthesia.
Procedure Type
Surgical type- Robotic / Open
Follow up
The doctor may suggest placing a small tube through the abdomen since feeding through the mouth is not recommended for a few weeks until the esophagus heals. After a few weeks, since the stomach size is reduced, it is important to eat small meals more frequently throughout the day. Due to this, most patients lose weight after surgery.
Risks
A few main risks of esophagectomy include
- Bleeding from the surgical site
- Pneumonia or other infections
- Leaking from the area where the stomach and esophagus are attached
- Blood clots and symptoms caused by it
- Change in the voice
- Infection of the surgical site
- Problems with swallowing anything
- Leakage from the lymph nodes
Recovery
Most people will improve their quality of life once they fully recover. It is important to follow all the instructions given by your doctor post-op. You should try to make any adjustments necessary to your lifestyle, which can cause less stress on the esophagus and will also improve recovery.
A few suggestions for recovery are:
- Change in diet
- Breathing exercises
- Medications for pain management
- Medications for problems with swallowing or heartburn.
- Any psychological care if necessary.
- Nutritional supplements help in malnutrition and weight loss.
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