What Is an Esophagectomy?
An esophagectomy is surgery performed on the esophagus, the tube connecting the throat to the stomach. Usually, doctors do an esophagectomy to treat esophageal cancer. They remove part or all of the esophagus and then pull the stomach into the chest and neck to form a new esophagus. When used to remove cancerous cells, a surgery may be combined with chemotherapy, radiation therapy, or both.
Besides treating esophageal cancer, esophagectomy may be recommended for non-cancerous conditions such as strictures and end-stage achalasia (damage to the nerves of the esophagus), where previous procedures didn’t work. It may also be done when the esophagus gets damaged due to scarring or when a patient ingests something that destroys its lining. Moreover, a surgeon may recommend it when the esophagus fails to transport food.
There are two primary esophagectomy types: open esophagectomy and minimally invasive esophagectomy. In open esophagectomy, the surgeon makes large incisions in the abdomen, neck, or chest.
Minimally invasive esophagectomy removes the esophagus via small incisions in the abdomen or chest. Here, the surgeon may choose laparoscopy or thoracoscopy. Laparoscopy uses a tube with a light and camera at the end to guide the doctor as they perform surgery through the abdomen. On the other hand, thoracoscopy uses a similar device to perform surgery via the chest. Neither procedure requires the surgeon to make a large incision.
When preparing for esophagectomy, the patient meets with the doctor to discuss all of the options as well as risks, benefits and alternatives to surgery.
Also, if a patient smokes the doctor will ask them to quit, since smoking likely increases complication rates after surgery. In some cases, the doctor may recommend a cessation program. Besides, the individual should discuss with the surgeon any medication they are taking. The doctor may advise them to continue with some or stop others. Moreover, the doctor advises the patient on when to stop eating to clear the esophagus prior to surgery.
Before the procedure begins, there are a few things a patient can expect. These usually help the doctor determine the most appropriate approach. Healthcare providers may recommend imaging procedures, including computerized tomography (CT) and PET scan (Positive Emission Tomography).
During the surgery, besides removing the esophagus and reconnecting the remaining part of the stomach to the throat, the surgeon removes lymph nodes for cancer examination. If these have cancerous cells, the cancer will have spread beyond the esophagus, and the patient will require additional treatment procedures.
The surgeon follows the patient closely after surgery to gauge progress.
