Esophagectomy - open
Definition
An esophagectomy is surgery to
remove part or all of the esophagus, the tube that moves food from
your throat to your stomach. After it is removed, the esophagus is
rebuilt from part of your stomach or part of your large
intestine.
Most of the time, esophagectomy
is done to treat cancer of the
esophagus.
Alternative Names
Trans-hiatal esophagectomy;
Trans-thoracic esophagectomy; En bloc esophagectomy; Removal of the
esophagus - open
Description
There are many ways to do this
surgery. Talk with your doctor about what type of surgery is best
for you. It will depend on where in your esophagus your cancer is,
how much it has spread, and how healthy you are.
Laparoscopy is one way to do this
surgery. A laparoscope is a tiny camera that is inserted into your
belly through a small incision. See also: Esophagectomy - minimally
invasive
Open surgery is another way to do
an esophagectomy. Two ways to do an esophagectomy using open
surgery are:
Trans-hiatal
esophagectomy:
- Your surgeon will make 2 large
incisions (cuts), one in your neck area and one in your upper
belly.
- Your surgeon will close off part
of your stomach with staples and cut this section off. This part of
your stomach will be used to form a new section of your esophagus.
It will replace the part of your esophagus that will be
removed.
- Your surgeon will remove the
part of your esophagus where your cancer or other problems
are.
- Your surgeon will join together
your rebuilt esophagus and stomach in your neck.
- Lymph nodes in your neck and
chest may also be removed if your cancer has spread to
them.
Trans-thoracic
esophagectomy:
- Your surgeon will make 2
incisions, one in your chest and one in your upper
belly.
- Your surgeon will close off part
of your stomach with staples and cut this section off. This part of
your stomach will be used to form a new section of your esophagus.
It will replace the part of your esophagus that will be
removed.
- Your surgeon will remove the
part of your esophagus where your cancer or other problems
are.
- Your surgeon will join together
your rebuilt esophagus and stomach in your neck.
- Lymph nodes in your neck and
chest may also be removed if your cancer has spread to
them.
Your surgeon may also examine and
do a biopsy of the lymph nodes in your belly to see if your cancer
has spread to them.
En bloc esophagectomy is another
type of esophagectomy. It is the most invasive of all of these
procedures.
- To do it, your surgeon will make
large cuts in your chest and belly. All of your esophagus and part
of your stomach will be removed.
- The rest of your stomach will be
reshaped and placed in your chest to replace your
esophagus.
- Your surgeon will also remove
all lymph nodes in your chest and belly.
Most of these operations take
about 3 hours.
Why the Procedure Is Performed
The most common reason for
removing part, or all, of your esophagus is to treat cancer. You
may also have radiation therapy or chemotherapy before or after
surgery.
Surgery to remove the lower part
of your esophagus may also be done to treat:
- Pre-cancerous changes in the
tissue of your esophagus. This condition is called high-grade
dysplasia.
- Achalasia, a condition where the esophagus
doesn’t work well
Risks
Esophagectomy is major surgery
and has many possible risks. Some of them are serious. You should
discuss these risks with your surgeon.
The risks from this surgery, or
for problems after surgery, may be greater than normal
if:
- You are unable to walk even for
short distances. This increases the risk of blood clots, lung
problems, and pressure sores.
- You are an older child who is
still growing.
- You are older than 60 to
65.
- You are a heavy
smoker.
Risks for any anesthesia
are:
Risks for any surgery
are:
Risks for this surgery
are:
- Injury to the stomach,
intestines, lungs, or other organs during surgery
- Leakage of the contents of your
esophagus or stomach where the surgeon joined them
together
- Narrowing of the connection
between your stomach and esophagus
Before the Procedure
You will have many doctor visits
and medical tests before you have this surgery. Some of these
are:
- A complete physical
examination
- Visits with your doctor to make
sure other medical problems you may have, such as diabetes, high
blood pressure, and heart or lung problems, are under
control
- Nutritional
counseling
- A visit or class to learn what
happens during the surgery, what you should expect afterward, and
what risks or problems may occur afterward
If you are a smoker, you should
stop several weeks before the surgery. Your doctor or nurse for can
help.
Always tell your doctor or
nurse:
- If you are or might be
pregnant
- What drugs, vitamins, and other
supplements you are taking, even ones you bought without a
prescription
- If you have been drinking a lot
of alcohol, more than 1 or 2 drinks a day
During the week before your
surgery:
- You may be asked to stop taking
drugs that make it hard for your blood to clot. Some of these are
aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin),
and clopidogrel (Plavix),or ticlopidine (Ticlid).
- Ask your doctor which drugs you
should still take on the day of your surgery.
- Prepare your home for after the
surgery.
On the day of your
surgery:
- Do not eat or drink anything
after midnight the night before your surgery.
- Take the drugs your doctor told
you to take with a small sip of water.
- Your doctor or nurse will tell
you when to arrive at the hospital.
After the Procedure
Most people stay in the hospital
for 7 to 14 days after an esophagectomy. How long you stay will
depend on what type of surgery you had. You may spend 1 to 3 days
in the intensive care unit (ICU) right after surgery.
You will stay in the hospital for
10 to 14 days after en bloc esophagectomy
During your hospital stay, you
will:
- Be asked to sit on the side of
your bed and walk on the same day you had surgery
- Not be able to eat for at least
the first 2 to 3 days after surgery. After that, you will begin
with liquids. You will be fed through a feeding tube that goes into
your intestine.
- Have a tube coming out of the
side of your chest to drain fluids that build up
- Wear special stockings on your
feet and legs to prevent blood clots
- Receive shots to prevent blood
clots
- Receive pain medicine through an
IV or take pills. You may receive your pain medicine through a
special pump. With this pump, you press a button to deliver pain
medicine when you need it. This allows you to control the amount of
pain medicine you get.
- Do breathing
exercises
Outlook (Prognosis)
Many people recover well from
this surgery and can eat a fairly normal diet after they recover.
Talk with your doctor about the best way to treat your
cancer.
References
Maish M. Esophagus. In: Townsend
CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook
of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;
2008:chap 41.
Review Date: 2/17/2009
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery,
Columbia University College of Physicians and Surgeons, New York,
NY. Review provided by VeriMed Healthcare Network. Also reviewed by
David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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