An esophagectomy is a surgical technique used for treating esophageal cancer, involving the careful dissection and removal of the esophagus from the body. It is important to properly diagnose and stage esophageal cancer to determine whether surgery is the right treatment for an individual. In addition, while surgical resection is the recommended treatment for many cases of esophageal cancer, it's important to speak with your thoracic surgeon to determine whether surgery is the right treatment option for you.
Appropriate patient selection, good hospital care during and after surgery, and surgeon expertise are essential in having positive surgical outcomes. At Mercy, we believe this comprehensive approach is critical to ensuring the best outcomes for even the most complex cases, that's why we've developed a program focused on our patients' needs from early diagnosis through surgery and rehabilitation.
How Does An Esophagectomy Work?
An esophagectomy is most commonly performed by a thoracic surgeon, using approximately a four centimeter incision made in the neck and an eight centimeter incision made in the stomach above the umbilicus (belly button). During the procedure, the patient is asleep under general anesthesia. These numbers are an estimate and the actual incisions may be smaller or larger depending on the individual's body shape.
First the stomach is carefully dissected out of its normal position. Many of the stomach's arteries (vessels carrying oxygen and nutrients to the body) are preserved. The esophagus is then carefully dissected completely out of the body. A small length of esophagus is left in the neck, but it is important to have some space between the cancer removed and the esophagus left in the body to help prevent the cancer from returning. The actual length of esophagus removed depends on the cancer.
Next, the stomach is reconstructed into a tube shape and is brought up through the chest and attached to the proximal esophagus to form a new esophagus.
Patients will not eat by mouth for one week after surgery. A small feeding tube is placed into the small bowel so the patient can continue to get good nutrition for the week following the surgery. Good nutrition is essential in the healing process of the body.
After surgery, the patient will have a nasogastric tube - a hollow tube that enters in the nose and goes down through the new "esophagus." This tube allows the stomach and esophagus to heal after surgery and form a new esophagus for swallowing food. Generally the tube will stay in for one week. After that time, the patient will have the nasogastric tube removed and will start a full liquid diet for two weeks.
After the two-week period, the patient will have a soft modified diet for three to six months.
Generally, patients can expect to remain in the hospital approximately seven days following an esophagectomy. During this time, you will work with your thoracic surgery team, physical therapist, respiratory therapist, nurses and a registered dietician to optimize your care and ensure you are prepared you to go home.