Esophagectomy is a surgical procedure to remove some or all of the swallowing tube between your mouth and stomach (esophagus) and then reconstruct it using part 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. An esophagectomy may also be recommended for noncancerous conditions when prior attempts to save the esophagus have failed, such as with end-stage achalasia or strictures, or after ingestion of material that damages the lining of the esophagus.
Esophagectomy is the main surgical treatment for esophageal cancer. It is done either to remove the cancer or to relieve symptoms.
During an open esophagectomy, the surgeon removes all or part of the esophagus through an incision in the neck, chest or abdomen. The esophagus is replaced using another organ, most commonly the stomach but occasionally the small or large intestine.
In most circumstances, esophagectomy can be done with minimally invasive surgery, either by laparoscopy, robot assisted or a combination of these approaches. 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:
Your doctor and team will discuss concerns you may have about your surgery. If you have cancer, your doctor may recommend chemotherapy or radiation or both, followed by a period of recovery, before an esophagectomy. These decisions will be made based on the stage of your tumor, and staging must be complete prior to any discussion about treatment before 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.
Talk to your doctor about:
Your treatment team may recommend that you bring several items to the hospital including:
Talk to your doctor about:
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.
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) imaging, as well as endoscopy with biopsies, and endoscopic ultrasound-guided fine-needle biopsies during endoscopy.
An esophagectomy involves removing some or most of the esophagus, a portion of the top of the stomach and nearby lymph nodes if cancer is involved. How much of the esophagus and stomach are removed depends on the stage of the cancer and where it's located. In some circumstances, a portion of the intestine — rather than the stomach — may be pulled up and connected to the esophagus.
Depending on your situation, the surgeon will choose one of the following surgical techniques:
Your doctor will likely recommend tube feeding (enteral nutrition) through a small tube placed through your abdomen that connects to the small bowel. This type of feeding will continue 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: