There are two treatment options for esophageal cancer. Esophagectomy is the surgical removal of the esophagus, and esophagogastrectomy is the surgical removal of your esophagus and a portion of your stomach. Both of these procedures can also be options for patients with achalasia or Barrett’s esophagus if precancerous cells are present.
This procedure is recommended when the cancer has not spread to other parts of your body and is potentially curable. During this procedure, the surgeon removes the part of the esophagus that contains the tumor and nearby lymph nodes. The remaining esophagus is reconnected to your stomach. This is usually done by pulling the stomach up to meet the remaining esophagus. In some situations, a portion of the colon is used to replace the missing section of the esophagus.
There are several different techniques when it comes to performing this surgery. Your surgeon will decide which approach is appropriate for you based on your health, the size and location of the tumor and involvement of the tissue and organs near the tumor.
Techniques of Esophagectomy
- Trans-hiatal esophagectomy: incisions are made in your abdomen and neck to gain access to your esophagus
- Trans-thoracic esophagectomy: incisions are made in your abdomen and the right or left side of your chest to gain access to your esophagus
- En bloc esophagectomy: the most invasive of these procedures. Your surgeon makes large cuts in your neck, chest and stomach. Your entire esophagus is removed. Your stomach is then reshaped into a tube and placed in your chest to replace your esophagus. The stomach will be connected to the remaining esophagus in the neck. The surgeon will also remove all lymph nodes in your chest and stomach.
- Laparoscopic esophagectomy: minimally invasive procedure in which your surgeon gains access to your esophagus using a series of small incisions and performs the procedure with a laparoscope that has a tiny camera attached at the end of it.
Esophagogastrectomy is the surgical removal of your esophagus as well as a portion of your stomach. The esophagus is then replaced in one of two ways: by moving the remaining portion of the stomach upwards or by replacing it with a section of the large intestine. Your doctor will discuss with you which procedure is best for you depending on your situation.
This procedure can either be performed as an open procedure with a large incision or as a laparoscopic procedure using small incisions and a laparoscope to navigate.
Preparing for an Esophagectomy/Esophagogastrectomy
Your surgeon will give you any specific instructions about dietary or activity restrictions and will instruct you about whether you should take your regular medications on the day of the procedure. You will also be asked to not eat or drink after midnight on the night before your procedure.
What Happens During an Esophagectomy/Esophagogastrectomy?
In some cases, you will be admitted to the hospital the day before your surgery. This is so antibiotics can be given and bowel preparation can be completed if necessary. Bowel preparation involves drinking a solution that will empty your bowel before the surgery. Esophagectomy and esophagogastrectomy are performed under general anesthesia and is a complex, time-consuming procedure. What happens once the procedure begins depends on the approach your surgeon takes. These procedures can take anywhere from 5 to 10 hours depending on the approach.
What Happens after an Esophagectomy/Esophagogastrectomy?
After the surgery is completed, you will have to stay in hospital for 7 to 14 days to recover. You may also have to spend 1 to 3 days in the intensive care unit (ICU). You will not be able to eat for the first two to three days after surgery. After that you’ll start with a liquid diet, being fed through a feeding tube. Most people recover well from surgery and can eat a fairly normal diet after recovery.
Esophagectomy and esophagogastrectomy are major surgeries and have many possible risks. Make sure you discuss these risks with your doctor before the procedure.