Esophagectomy and esophageal resection are surgical procedures that involve the removal of a portion, or all, of the esophagus, surrounding lymph nodes and sometimes a portion of the stomach. Most frequently, an esophagectomy and an esophageal resection are performed to treat early-stage cancer of the esophagus before the cancer has metastasized to the stomach or other organs. These procedures may also be a treatment for Barrett's esophagus or esophageal dysplasia, precancerous conditions of the cells lining the esophagus. Less often, an esophagectomy and esophageal resection are performed when there has been irreversible damage to the esophagus as a result of traumatic injury, the swallowing of a caustic substance, chronic inflammation or motility issues which interfere with the passage of food during the digestive process.
Indications of esophageal disorders which may necessitate an esophagectomy and esophageal resection may include the following:
- Difficult or painful swallowing, known as dysphagia
- Unexplained weight loss
- Hiccups
- Pressure or burning in the chest region
- Hoarseness
- Lung disorder
Types of Esophagectomy Procedures
Esophagectomy and esophageal resection may be done as open abdominal surgery or laparoscopically. When possible, a laparoscopy is the preferred surgery since it is less invasive and involves smaller incisions, resulting in less pain, less scarring and a shorter recovery period. Laparoscopic surgery may be done if the procedure is performed to remove cancerous tissue and the cancer has not metastasized. If open surgery is required, it may take one of three forms:
Transhiatal Esophagectomy
In a transhiatal esophagectomy procedure, the surgeon makes two large incisions, one in the patient's neck and one in the upper belly. After removing the diseased tissue, the surgeon will rejoin the rebuilt esophagus and the stomach.
Transthoracic Esophagectomy
In a transthoracic procedure, the surgeon will make one incision in the patient's chest and one in the upper belly. The esophagus will be removed and the stomach will be used to form a new tube to replace it.
En Bloc Esophagectomy
The en bloc procedure is the most invasive type of esophagectomy. In this procedure, the surgeon makes cuts in the neck, chest and belly. All of the esophagus and part of the stomach are removed. The remaining piece of the stomach is formed into a tube and attached to the remnant of the esophagus.
In all three of these procedures, the patient will have a feeding tube in place during early recovery to allow the digestive tract to heal. In all three, the surgeon will remove nearby lymph nodes for biopsy to ascertain whether the existing cancer has spread.
Risks of Esophagectomy and Esophageal Resection
As with any surgical procedure, there are risks associated with this surgery. The usual risks of surgery are present, and may include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
Risks particular to esophagectomy and esophageal resection include the following:
- Acid reflux
- Leakage of digestive contents at the site of reconnection
- Narrowing of the connection between stomach and esophagus
Risks after surgery will be greater if the patient is:
- Not yet an adult
- Mobility impaired
- Age 60 or older
- A heavy smoker
- Obese
- Underweight
- On corticosteroids
Recovery from Esophagectomy and Esophageal Resection Procedure
Depending on the extent of the surgery, recovery from an esophagectomy and esophageal resection will require one to two weeks of hospitalization, two to three days of which will be spent in intensive care. For several days, the patient will be fed through a feeding tube until normal eating is gradually resumed. The patient will have a chest drain to remove excess fluid from around the lungs and will be required to wear special stockings to prevent blood clots. Pain medications and medication to prevent blood clots will be administered either orally of intravenously. The patient will be taught breathing exercises to prevent a lung infection from developing.
During recovery, if the procedures have been performed as a treatment for cancer, the patient will begin or resume cancer treatments including chemotherapy or radiation therapy.
