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Esophagectomy

(Removal of the Esophagus)

Definition

This is surgery to remove part or all of the esophagus. The esophagus is the tube that runs from the mouth to the stomach.

Reasons for Procedure

Esophagectomy may be used to treat:
  • Esophageal cancer
  • Benign tumors and cysts of the esophagus
  • Other esophageal abnormalities such as achalasia or Barrett esophagus
  • Severe trauma
Esophageal Cancer
Esophageal cancer
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Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding
  • Blood clots
  • Infection
  • Soreness in throat
  • Adverse reaction to the anesthesia
  • Leaks from the internal suture line
  • Heart attack
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect

Prior to Procedure

Your doctor may do the following:
Leading up to your procedure:
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets
  • 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 medications.
    • 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:
  • An open procedure using one large incision—The diseased area will be located and removed.
  • A robot-assisted procedure that uses several small incisions—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 or large intestine. 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?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

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

At the Hospital
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 may be smaller, so you will need to eat smaller portions.
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.
Other guidelines include:
  • Walking every day.
  • Avoid heavy lifting for 6-8 weeks.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision

Call Your Doctor

Call your doctor if any of the following occur:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persistent nausea and/or vomiting
  • Pain that you cannot control with the medications you have been given
  • Cough, shortness of breath, or chest pain
  • Constipation or diarrhea
  • Pain and/or swelling in your feet, calves, or legs
If you think you have an emergency, call for medical help right away.

RESOURCES

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

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

CANADIAN RESOURCES

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

Health Canada http://www.hc-sc.gc.ca

References

Esophagectomy. Boston Medical Center website. Available at: http://www.bmc.org/esophagealtherapies/treatments/esophagectomy.htm. Accessed August 14, 2013.

Esophagectomy. Massachusetts General Hospital website. Available at: http://www.massgeneral.org/digestive/services/procedure.aspx?id=2296. Accessed August 14, 2013.

Esophagectomy. Memorial Hermann website. Available at: http://www.memorialhermann.org/digestive/esophagectomy. Accessed August 14, 2013.

Esophagectomy. University of California San Francisco website. Available at: http://surgery.ucsf.edu/conditions--procedures/esophagectomy.aspx. Accessed August 14, 2013.

Surgical removal of the esophagus (esophagectomy). UC Davis Health System website. Available at: http://www.ucdmc.ucdavis.edu/surgery/specialties/cardio/esophagus.html. Accessed August 14, 2013.

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