Esophagectomy
An esophagectomy, also known as esophageal resection, is a surgical procedure during which part or all of the esophagus, including nearby lymph nodes, is removed. This operation is usually performed to remove malignant tissue. In order for normal digestion to continue, the esophagus is reconstructed from part of the stomach or large intestine.
An esophagectomy can be performed as open abdominal surgery or laparoscopically. Whenever possible, laparoscopy is preferred because it is less invasive and involves smaller incisions, resulting in less pain, less scarring and a shorter recovery period. If the cancer has metastasized, however, laparoscopic surgery is not usually appropriate.
Reasons for an Esophagectomy
In addition to being performed to remove cancerous tissue, an esophagectomy may be necessary to treat the following:
- Barrett's esophagus or esophageal dysplasia
- Esophageal damage due to traumatic injury
- Damage due to swallowing of a caustic substance
- Chronic inflammation
- Digestive-motility issues
Digestive-motility (movement) issues are typically caused by achalasia, a condition in which the muscle of the esophagus does not work properly.
The Esophagectomy Procedure
Usually a bowel preparation is required before an esophagectomy to ensure that the intestinal tract is thoroughly cleansed. When an open surgery is necessary for an esophagectomy, it may be performed in one of three ways, depending upon how much, and which part, of the esophagus requires removal:
- Transhiatal esophagectomy
- Transthoracic esophagectomy
- En bloc esophagectomy
The most invasive and complex of these three procedures is the en bloc, in which part of the stomach is also removed. All three operations are performed under general anesthesia, and all include removal of lymph nodes so they can be checked for metastasis. The length of time needed for the operation varies widely, from 3 to 10 hours, depending on exactly what has to be done.
Recovery from an Esophagectomy
After an esophagectomy, the patient is carefully monitored, first in the recovery room, and then in the intensive care unit. After a few days, the patient is moved to a regular room. An inpatient stay of 1 to 2 weeks is necessary. The patient has a feeding tube in place during early recovery to permit healing in the digestive tract. After several days, the tube is removed, and the patient gradually resumes eating a normal diet.
The patient also has a temporary chest drain inserted to remove excess fluid from the chest cavity, and wears compression stockings to prevent blood clots. Pain medication and blood thinners are administered, either orally or intravenously. During recovery, the patient is instructed in breathing exercises to prevent development of a lung infection.
Before discharge, patients are taught how to care for their incision sites. Some assistive care in the home is usually required during recuperation. Patients are typically able to return to normal activities in 4 to 6 weeks. For some patients with cancer, radiation and/or chemotherapy is required after surgery.
Risks of an Esophagectomy
As with all surgical procedures, there are risks involved in an esophagectomy. They include the usual risks of surgery: excessive bleeding, infection, blood clots, and adverse reaction to anesthesia or medication. Risks of this particular procedure include the following:
- Acid reflux
- Leakage of digestive contents at reconnection site
- Narrowing of the connection between the esophagus and stomach
The risks of postsurgical complications are greater if the patient smokes, drinks alcohol to excess, or has been taking corticosteroid medication prior to surgery.