Esophagectomy | Gastroenterology


Overview of esophagectomy

An esophagectomy is the removal of part or all of the swallowing tube between the mouth and stomach (esophagus) and then the reconstruction of another organ, usually using part of the stomach. Esophagectomy is a common treatment for advanced esophageal cancer and is occasionally used for Barrett’s esophagus if there are pre-existing cells that are aggressive.

When previous attempts to protect the esophagus fail, the esophagus may also be recommended for non-cancerous conditions, such as end-stage achalasia or after taking a substance that damages the lining of the esophagus.

Why it’s done?

Esophageal cancer can be treated with Esophagectomy which is the main surgical procedure. This is done to kill cancer or relieve symptoms.

During an open esophagectomy, an incision in the neck, chest, or abdomen made through which the esophagus is removed. The esophagus is replaced using another organ, usually the stomach, but occasionally the small or large intestine.

In most cases, laparoscopy, robot-assisted, or a combination of these procedures can be performed with minimally invasive esophagectomy. When the individual condition is appropriate, these procedures are performed through several small incisions, and pain is reduced and recovers faster than conventional surgery.

Is the procedure safe?

There are risks with any meaningful approach. However, many studies have shown that the results are higher in hospitals like a mass general. The overall massive complication rates of esophagectomy for cancer are significantly lower than the national average. The surgeon will detail these risks before performing any surgical procedure.

Research published by the mass general division of thoracic surgery shows that patients with less invasive esophagectomy (compared to standard open esophagectomy) recover faster due to fewer breathing problems and shorter hospital stays. Mass general handles 57% of these activities with a minimally invasive technique, resulting in fewer problems. Research has shown that the results of standard and minimally invasive esophagectomy are similar to those of cancer outcomes or cancer survival.

Preparation for esophagectomy

Before esophagectomy, most patients undergo imaging procedures such as computed tomography (CT) or positron emission tomography-computed tomography (PET / CT) and evaluation of cardiovascular fitness. Patients also see an anesthesiologist before the procedure. The preoperative examination is prior to the MIE or open procedure.

If the procedure is done for cancer, the patient often sees an oncologist and receives chemotherapy and radiation.

How is the procedure performed?

The procedure is performed in an operating room at a hospital or clinic with a general or thoracic surgeon.

There are three types of open esophagectomies performed by a surgeon:

Transthoracic esophagectomy (TTE): A TTE is done through the chest. With cancer, the section of the esophagus and the upper part of the stomach are removed. The esophagus and the rest of the stomach are connected to rebuild the digestive system. In some cases, part of the colon is used to replace the removed section of the esophagus. Lymph nodes in the chest or neck can also be removed if they are cancerous.

Transthoracic esophagectomy (TTE) is used to:

  • Two-thirds of esophageal cancers
  • Dysplasia in a condition called Barrett’s esophagus
  • Destroy two-thirds of the esophagus by swallowing a caustic agent
  • Complications of reflux esophagitis that cannot be improved with other procedures

Transhiatal esophagectomy (THE): During a transient esophagectomy (THE), the esophagus is removed without opening the esophagus. Instead, an incision is made from the bottom of the breastbone to the belly button. Another small incision is made on the left side of the neck. The surgeon removes the esophagus, moves the abdomen to the neck area where the esophagus is removed and connects the rest to the stomach at the neck. Lymph nodes in the chest or neck can also be removed if they are cancerous.

Transhiatal esophagectomy (THE) is used to:

  • Eliminate esophageal cancer
  • Remove the esophagus after using other procedures to treat esophageal cancer.
  • Narrow or squeeze the esophagus to make swallowing less difficult
  • Adequate problems with the nervous system.
  • Repair of recurrent gastroesophageal reflux
  • Repair a hole or wound caused by a caustic agent such as Ly

En-Bloc esophagectomy: En-Bloc esophagectomy is the most radical esophageal procedure. During this procedure, your doctor will remove the esophagus, part of the abdomen, and all the lymph nodes in the chest and abdomen. The surgery is done through the neck, chest, and abdomen. Your doctor will redesign the rest of the abdomen and raise it through the chest instead of the esophagus.

Radical N-esophagectomy is used to treat a curable tumor.

After the esophagectomy

The information in this section tells you what to expect after surgery, while you are in the hospital, and after you leave the hospital. And what to do to safely recover from your surgery.

Be sure to write down your questions and ask your doctor or nurse.

When you wake up after surgery, you will be in the Post Anesthetic Care Unit (PACU). A nurse checks your body temperature, pulse, blood pressure, and oxygen levels. It receives oxygen through a narrow tube under the nose called a nasal cannula. There are also compression shoes on the lower legs.

  • You have tubes and drains for your body to heal from surgery. You may have the following:
  • The urinary catheter in the bladder controls the amount of urine you urinate.
  • 1 or 2 chest tubes are attached to the tubes that enter the drainage device (see Figure 2).
  • Nasogastric tube (NG tube) in the nose. This tube goes into your stomach to keep it empty.
  • Jejunostomy tube (feeding tube) in your abdomen. This tube goes into the small intestine to feed you when you can’t eat.
  • A pain pump called patient-controlled analgesia (PCA) device. It may also have other pipes and drains. If you do, your nurse will explain why you are in the hospital and take care of them.
  • Your visitors can briefly see you in the PACU, usually within 90 minutes of arrival. A member of the nursing staff explains the guidelines.
  • You will spend the night at the PACU. Your visitors may not stay in your room overnight, but they can visit you at night.

Risks factors of the esophagectomy

Main risks of esophagectomy:

  • Pneumonia
  • Leak at the point where the stomach and esophagus are connected
  • Bleeding
  • Blood clots
  • Rough throat
  • Infection
  • Swallowing problems
  • Lymphatic loss
  • Short-term risks include reactions to anesthesia, more bleeding than expected, blood clots in the lungs or elsewhere, and infections. Most people feel at least some pain after the operation, which usually helps with pain relievers.
  • Lung problems are common. Pneumonia develops, which can lead to a long hospital stay and sometimes even death.
  • Some people may have voice changes after surgery.
  • There may be a leak in the area where the stomach (or intestine) connects to the esophagus, which may require another operation to repair it. This is not as common due to improved surgical procedures.
  • Stiffness (narrowing) occurs where esophageal surgery connects to the stomach, causing some patients to have trouble swallowing. To alleviate this symptom, these terms can be extended during the upper endoscopy procedure.
  • After surgery, the stomach can empty very slowly because of the nerves that contract it can be surgically damaged. Sometimes it can cause nausea and vomiting.
  • After surgery, stomach contents and bile can back up into the esophagus because the ring-shaped muscle (lower esophageal sphincter) that normally holds them within the stomach is often surgically removed or replaced. It causes symptoms like heartburn. Sometimes antacids or kinetics can help with these symptoms.

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