• Esophagectomy

    (Removal of the Esophagus)

    Definition

    Esophagectomy is a procedure 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
    Esophageal cancer
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    Possible Complications

    Problems from the procedure can occur, 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, which may cause scarring and need for dilations
    • 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 will likely 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 1 week before the procedure
    • 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. You will be asleep during the procedure.

    Description of the Procedure

    Depending on the area that needs to be removed, the doctor will make an incision in the neck, chest, or abdomen using one of these techniques:
    • An open procedure using 1 large incision. The diseased area will be located and removed.
    • A laproscopic 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 diseased area will be located and removed.
    • A robot-assisted procedure
    A replacement esophagus will be formed with part of the stomach or large intestine. The remainder of the esophagus will be attached to this replacement. In some cases when treating cancer, lymph nodes in the area will also be removed. 1 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 6 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.
    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
    At Home
    Home care includes:
    • Avoiding heavy lifting for 6-8 weeks
    • Doing home exercises
    • Following your doctor's instructions

    Call Your Doctor

    Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
    • 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've been given
    • Cough, shortness of breath, or chest pain
    • Constipation or diarrhea
    • Pain and/or swelling in your feet, calves, or legs
    • Trouble swallowing
    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 May 6, 2016.

    Esophagectomy. Massachusetts General Hospital website. Available at: http://www.massgeneral.org/digestive/services/procedure.aspx?id=2296. Accessed May 6, 2016.

    Esophagectomy. Memorial Hermann website. Available at: http://www.memorialhermann.org/digestive/esophagectomy. Accessed May 6, 2016.

    Esophagectomy. University of California San Francisco website. Available at: http://surgery.ucsf.edu/conditions--procedures/esophagectomy.aspx. Accessed May 6, 2016.

    Surgical removal of the esophagus (esophagectomy). UC Davis Health System website. Available at: http://www.ucdmc.ucdavis.edu/surgery/specialties/cardio/esophagus.html. Accessed May 6, 2016.

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