Definition and Overview
Esophagectomy is a surgical procedure that removes a part or the whole esophagus. It can be either open (traditional method) or minimally invasive. In certain situations, the procedure also necessitates the removal of a part of the stomach.
The esophagus is part of the digestive system that connects the larynx or the throat to the stomach. Several problems can affect this part of the body, such as the loss of ability to contract or relax or damage to its structures after being exposed to harmful stomach acids. It can also develop serious conditions due to trauma and other diseases. These result in the patient having difficulty breathing or problem in absorbing much-needed nutrients from food.
Esophagectomy is performed to relieve, treat and manage these conditions.
Who Should Undergo and Expected Results
Not all types of problems affecting the esophagus require esophagectomy. For example, an acid reflux or heartburn can be treated with medications or change in lifestyle. However, it is necessary in the following situations:
Esophageal cancer – Surgery is often a part of treatment for patients with esophageal cancer. The extent of surgery depends on the stage and location of the tumour, as well as the overall health of the patient. If the problem is in the lower region, for example, a part of the esophagus and the stomach may be removed. If the cancer is in the upper part, a large portion of the esophagus will be most likely to be removed. The procedure may also be combined with other treatments like chemotherapy or radiation therapy.
Trauma – Injuries that affect the neck and throat can also affect the esophagus. The same thing can be said on the trachea since the esophagus is only behind it. An example of a traumatic injury is when the throat and the esophagus are crushed due to a vehicle accident.
Stomach conditions – Serious problems of the stomach, such as cancer, are more likely to have an impact on the esophagus, particularly the lower region.
How Does the Procedure Work?
Prior to the surgery, the patient undergoes a battery of tests to ensure that (1) he is fit to go through the procedure and (2) he is a viable candidate for it. Otherwise, other forms of treatment will be explored.
Aside from physical and blood tests, the surgeon will also perform imaging exams to identify the exact location of the tumour and assess the condition of the esophagus and nearby organs like the stomach and the intestine. These tests are crucial when planning the surgery and ensuring the safety of the patient.
The surgeon will also discuss the following with the patient:
- Risks and complications
- Nutrition before and after the surgery
- Possible outcomes
- Complementary therapies or treatments
- Post-operative care
- Prognosis of the disease after the esophagus removal
As for the procedure, it can be open or minimally invasive.
In an open or traditional procedure, the surgeon can use any of the following incision techniques: trashiatal (incision in the belly and neck), transthoracic (incision in the chest and belly), and en bloc (incision in the belly, neck and chest). The decision on which to use depends on the location of the part of the esophagus that is damaged, if a part of the stomach also have to be removed and the resection that is needed.
Traditional esophagus removal surgery is performed under general anaesthesia regardless of the type of incision to be used. The patient’s vital signs like the heart rate and blood pressure will be closely monitored by the anaesthesiologist. A catheter is also attached to the bladder for urination.
The surgery entails making large incisions to access the esophagus. Using surgical tools, a part or the entire esophagus is cut and removed. If the problem affects the stomach, a portion of it will also have to be taken away. If part of the esophagus remains, the stomach is resected, reshaped and connected to it. Otherwise, the surgeon takes a part of the intestine, reshapes it into a tube, and uses it to connect the throat to the stomach. If the cancer has already spread, the lymph nodes found in the neck and chest will also be removed. A tube is attached temporarily for feeding until the patient fully recovers from surgery.
An open surgery may take at least 4 hours to complete. The patient may have to stay in the hospital for 1 to 2 weeks and is expected to recover within six months.
A laparoscopic procedure, meanwhile, is recommended if the disease or the damage to the esophagus is still in its earliest stages. It involves making small incisions to access the esophagus. A scope, with a camera attached, is then inserted, sending live images of the organ and its surrounding tissues to a monitor. The surgeon then operates using microsurgical instruments.
Risks and Complications
Risks and complications of the esophagus removal procedure include:
- Allergic reactions to medications and anesthesia
- Poor blood clotting or formation of blood clots
- Acid reflux
- Damage to the other organs
Maish M. Esophagus. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 43.
National Cancer Institute: PDQ esophageal cancer treatment. Bethesda, MD: National Cancer Institute. Date last modified February 18, 2015. Available at: www.cancer.gov/c