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Esophagectomy
Esophagectomy is a surgery performed to remove a part of or the complete esophagus and sometimes may involve a part of the stomach. The esophagus is the tube connecting the throat and the abdomen through which food travels.
Why is esophagectomy performed?
Esophagectomy may be performed to treat the following cases
- Cancer.
- Barrett’s esophagus.
- Esophageal narrowing. This may be caused due to acid reflux, or a surgical injury.
The extent of the procedure and the amount of esophagus removed will depend on many factors. Some factors are disease size and location. Esophagectomy is most often performed for esophageal cancer. In this type of cancer, malignant tumours grow in the esophagus. If patients with benign tumors are unable to swallow, doctors may recommend esophagectomy.
What are the types of esophagectomy?
There are several different types of esophagectomy. It is classified based on the number of incisions and also the location of the incisions. Surgeons decide this based on their experience; factors such as the location of the tumor and the overall patient health plays a role.
Types of esophagectomy include the following:
Transhiatal esophagectomy: In this type of esophagectomy,incisions are made in the neck and abdomen.
McKeown esophagectomy: The incisions are made in the neck, chest, and abdomen bell. The esophagus is removed, and then the GI tract is rebuilt.
Thoracoabdominal esophagectomy: One large incision is made from the chest to the belly. This allows the surgeon to access the esophagus.
Ivor Lewis esophagectomy: In this procedure, an incision is made on the right side of the chest and another in the abdomen.
Minimally invasive esophagectomy: Surgeons make small incisions and then insert tools and a lighted camera. This could be a thoracoscope ( in case of the chest ) or a laparoscope ( in case of abdomen
A laparoscope is a long flexible instrument for examining and studying the abdomen.
Sometimes minimally invasive procedure components are mixed with open surgery components. This procedure is known as hybrid esophagectomy.
The surgeon who conducts esophagectomy, places a tube called jejunostomy tube. It is a feeding tube that helps to provide nutrition for 30 days until the patient can swallow on his own.
The surgeon might also add a nasogastric tube. This tube acts as a drain that goes through the nose. A Nasogastric machine is essential for keeping the stomach decompressed. This serves as a new connection from the esophagus to the stomach, providing faster healing.
Process of esophagectomy
The patient is administered anesthesia before the surgery. Usually, an epidural catheter is placed in the back before the patient goes to sleep. The surgeon then studies the area and determines the exact location and size of the tumor. He then proceeds to eliminate it. The doctor then reconnects the remaining esophagus to the stomach.
During the procedure, the surgeon will also remove the lymph nodes, which is sent to the lab for further testing. Lymph nodes are small oval-shaped structures that filter extracellular fluid or lymph. They are part of the immune system, and if there is malignancy found in lymph nodes, it indicates that cancer has spread outside the esophagus.
Post-operative care
After the procedure, the patient needs to stay in the intensive care unit for 1-2 days. The patient is now ready to be put off the ventilator. Slowly he is started on tube feeds, and the epidural will be adjusted to help in reducing the pain.
After two days, the patient can be shifted to the ward where he is gradually transitioned to liquid medication that can be placed down the feeding tube. The patient is advised to begin walking to aid in faster healing and recovery after the drain is removed. The doctors continuously monitor the patient to prepare his discharge from the hospital.
Post-surgery recovery from an esophagectomy will usually depend on the extent of the procedure you have had. Some times, a more extended hospital stay may be advised as per the process involved. During the procedure, the feeding tube that is put into the patient’s stomach will be used for about 1 to 2 months.
The patients are given in-depth instructions on post-operative care for incisions, and directions are given regarding the preventive medications to be taken to avoid any infection.
The healthcare provider will provide all information regarding activity restrictions that the patient needs to follow.