Esophagectomy is a surgical procedure to remove cancer from the esophagus. The esophagus is the tube between your mouth and stomach through which food passes.
Esophagectomy surgery often involves the removal of a small part of the stomach. The upper part of the esophagus is then attached to the remaining section of the stomach. The stomach is then pulled up slightly into the chest or neck to serve as the new esophagus.
An esophagectomy is also performed to treat noncancerous conditions, such as end-stage achalasia or strictures.
Other reasons for removing the esophagus could be precancerous conditions, severe scarring of the tube, or failure of the esophagus to transport food.
Finally, an esophagectomy could be performed if you ingest something that damages the lining of your esophagus.
How Is an Esophagectomy Performed?
If the lower part of the esophagus (nearby the stomach) has cancer, the surgeon will remove that part of your esophagus.
They will also remove a part of your stomach and about three to four inches of the unaffected esophagus above this. Then, they will connect the stomach to the remaining esophagus, either high in the chest or the neck.
If the upper or middle part of the esophagus has cancer, the surgeon will need to remove most of the esophagus to get enough tissue above the tumor.
Then, they will bring up the stomach to connect to the esophagus in the neck. If it seems complicated for the stomach to pull up, the surgeon may use a part of the intestine to fill the gap. If the blood vessels get damaged during this procedure, that part of the intestine will not get enough blood, and the tissue will die.
Esophagectomy requires a lengthy hospital stay. It can be done using different techniques. Two primary esophagectomy techniques are:
This is the standard technique in which the surgeon makes one or more large cuts in the abdomen (belly), chest, or neck.
- Transhiatal esophagectomy. This procedure is recommended when the cuts or incisions are in the neck and abdomen.
- Transthoracic esophagectomy or Ivor Lewis esophagectomy. Your doctor will recommend this when the cuts are in the chest and abdomen.
Some surgeries involve cuts in all three parts simultaneously.
Minimally Invasive Esophagectomy
This surgery is done when the esophageal cancer is diagnosed early, and the tumor is small. In this procedure, a robot can be used to remove the esophagus through multiple small incisions instead of large ones.
A laparoscope is put through one of the incisions to see the inside of the body. The other surgical tools are inserted through the other incisions.
These surgeries are more complicated than an open esophagectomy. That is why you must always opt for an experienced surgeon for the job.
The surgery uses smaller incisions so that you may leave the hospital sooner. You may also lose less blood and recover faster.
What Are Common Esophagectomy Complications?
Esophagectomy carries a high risk for complications. Some common esophagectomy complications are:
- Acid or bile reflux
- Leakage from the joining point of esophagus and stomach
- Changes in your voice
- Nausea or vomiting
- Respiratory problems, like pneumonia
- Dysphagia, a condition related to difficulties in swallowing
- Atrial fibrillation, a condition that causes an abnormal heartbeat
Following surgery, you won’t be able to eat or drink. You will need to be fed through a tube for 4-6 weeks, or until you fully recover. In this method, the food passes a small tube placed through your abdomen that connects to the small bowel.