Esophagectomy Overview

This is surgery to remove the esophagus. The esophagus is the tube that runs from the mouth to the stomach.

Prior to Procedure

Your doctor may do the following:

• Physical exam
• Blood and urine tests
• Chest x-ray —a test that uses radiation to take pictures of structures inside the body
• Ultrasound—a test that uses sound waves to examine structures in the body
• CT scan —a type of x-ray that uses a computer to take pictures of structures in the body
• MRI scan —a test that uses magnetic waves to make pictures of structures in the body
• Upper endoscopy —a thin, lighted tube inserted down the throat to examine the esophagus
• Place a feeding tube into your small intestine (may be done during the esophagectomy)

Leading up to your procedure:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
• Arrange for someone to drive you home from the hospital and to help you at home.
• Eat a light meal the night before. Do not eat or drink anything after midnight.
• Your doctor may ask you to:

• Use an enema to clear your intestines
• Follow a special diet.
• Take antibiotics or other medicines.
• Shower using antibacterial soap the night before the surgery.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery. A tube will be placed in your windpipe to help you breathe.

Description of the Procedure

Depending on the area that needs to be removed, the doctor will make an incision in the neck or abdomen using one of these techniques:

• One large incision (open procedure)—The doctor will locate the diseased area and remove it.
• Several small incisions ( robot-assisted procedure )—A tiny camera and small surgical instruments will be inserted through the incisions. Looking at the esophagus on a monitor, the doctor will locate and remove the diseased area.

A "replacement" esophagus will be formed with part of the stomach. The remainder of the esophagus will be attached to this new esophagus. In some cases, lymph nodes in the area will also be removed. One or more chest tubes will be placed to drain fluids. Lastly, the incisions will be closed with stitches or staples.

How Long Will It Take?

About six hours

How Much Will It Hurt?

You will feel pain as the anesthesia wears off. Ask your doctor about medicine to help with the pain.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is 1-2 weeks. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

You will not be able to eat or drink anything during the first week after surgery. You will get nutrition through a feeding tube. Within 7-14 days, you will have a swallowing test to check for leaks. If there are no leaks, your diet will gradually progress from clear liquids to soft, solid meals. You will probably be able to return to a normal diet after about a month. Your stomach will be smaller, so you will need to eat smaller portions.

Your doctor will encourage you to walk every day. Avoid heavy lifting for 6-8 weeks.

You will also need to do deep breathing exercises. You may be given an incentive spirometer. This is a device to help you breath deeply.

RESOURCES:

American Cancer Society
http://www.cancer.org/

National Cancer Institute
http://www.cancer.gov/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/

National Cancer Institute of Canada
http://www.ncic.cancer.ca/

References:

Esophageal cancer—esophagectomy. University of Maryland Medical Center website. Available at: http://www.umm.edu/thoracic/esoph_surgery.html . Accessed March 1, 2007.

Ivor Lewis esophagectomy. Roswell Park Cancer Institute website. Available at: http://www.roswellpark.org/PatientCare/TypesofCancer/Esophageal/EsophagealCenterPatientHandbook/IvorLewisEsophagectomy . Accessed March 1, 2007.

Robot-assisted thoracic procedures PIB. Health Library website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?account=hotk2 . Accessed March 1, 2007.