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Esophagectomy - minimally invasive

Definition

Minimally invasive esophagectomy is surgery to remove part or all of the esophagus This is the tube that moves food from your throat to your stomach. After it is removed, the esophagus is rebuilt from part of your stomach or part of your large intestine.

Most of the time, esophagectomy is done to treat cancer of the esophagus.

Alternative Names

Minimally invasive esophagectomy; Robotic esophagectomy; Removal of the esophagus - minimally invasive; Achalasia -

esophagectomy; Barrett esophagus - esophagectomy

Description

There are many ways to do this surgery. Talk with your doctor about which type of surgery is best for you. It will depend on where in your esophagus the cancer is, how much it has spread, and how healthy you are.

Laparoscopy is one way to do this surgery:

  • The surgeon will make three to four small cuts in your upper belly, chest, or lower neck. These cuts will be less than ½-inch long.
  • The laparoscope, with a camera on the end, will be inserted through one of the cuts into your upper belly. Video from the camera will appear on a monitor in the operating room. Other medical instruments will be inserted through the other cuts.
  • The surgeon will close off one part of your stomach with staples and cut this section off. This part of your stomach will be used to form a new tube to replace the part of your esophagus that is removed.
  • The surgeon will remove the part of your esophagus where your cancer is located, and any other related lymph nodes in the area.
  • The surgeon will join together your rebuilt esophagus and stomach in your neck or chest. Where they are joined will depend on how much of your esophagus was removed.
  • Lymph nodes in your chest may also be removed if your cancer has spread to them. The surgeon will remove them through a cut in the lower part of your neck.
  • The surgeon will place a feeding tube in your small intestine so that you can be fed while you are recovering from the surgery.

Some medical centers do esophagectomies using robotic surgery. In this type of surgery, a small camera and other instruments are inserted through small cuts in the skin. Your surgeon will do the surgery while operating a computer and watching the monitor. The surgeon controls the instruments and camera with a computer program.

These surgeries usually take 3 to 6 hours.

Why the Procedure Is Performed

The most common reason for removing part, or all, of your esophagus is to treat cancer. You may also have radiation therapy or chemotherapy before or after surgery.

Surgery to remove the lower part of your esophagus may also be done to treat:

  • A condition in which the ring of muscle in the esophagus does not work well (achalasia)
  • Severe damage of the lining of the esophagus that can lead to cancer (Barrett esophagus)
  • Severe trauma

Risks

Esophagectomy is major surgery and has many possible risks. Some of them are serious. You should discuss these risks with your surgeon.

Risks of this surgery, or for problems after surgery, may be higher than normal if:

  • You are unable to walk even for short distances, which increases the risk of blood clots, lung problems, and pressure sores
  • You are still growing
  • You are older than 60 to 65
  • You are a heavy smoker
  • You are obese
  • You have lost a lot of weight from your cancer
  • You are on steroid medications

Risks of anesthesia are:

Risks of surgery are:

Risks of this surgery are:

  • Acid reflux
  • Injury to the stomach, intestines, lungs, or other organs during surgery
  • Leakage of the contents of your esophagus or stomach where the surgeon joined them together
  • Narrowing of the connection between your stomach and esophagus

Before the Procedure

You will have many doctor visits and medical tests before you have surgery. Some of these are:

  • A complete physical examination
  • Visits with your doctor to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control
  • Nutritional counseling
  • A visit or class to learn what happens during surgery, what you should expect afterward, and what risks or problems may occur afterward

If you are a smoker, you should stop several weeks before surgery. Your doctor or nurse for can help.

Tell your doctor or nurse:

  • If you are or might be pregnant
  • What medicines, vitamins, and other supplements you are taking, even ones you bought without a prescription
  • If you have been drinking a lot of alcohol, more than one or two drinks a day.

During the week before surgery:

  • You may be asked to stop taking medicines that make it hard for your blood to clot. Some of these are aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and clopidogrel (Plavix),or ticlopidine (Ticlid).
  • Ask your doctor which medicines you should still take on the day of surgery.
  • Prepare your home for after surgery.

On the day of surgery:

  • Do not eat or drink anything after the midnight before surgery.
  • Take the medicines your doctor told you to take with a small sip of water.
  • Arrive at the hospital on time.

After the Procedure

Most people stay in the hospital for 7 to 14 days after an esophagectomy. How long you stay will depend on what type of surgery you had. You may spend 1 to 3 days in the intensive care unit (ICU) right after surgery.

During your hospital stay, you will:

  • Be asked to sit on the side of your bed and walk on the same day you had surgery
  • Not be able to eat for at least the first 2 to 3 days after surgery. After that, you will begin with liquids. You will be fed through a feeding tube that goes into your intestine.
  • Have a tube coming out of the side of your chest to drain fluids that build up
  • Wear special stockings on your feet and legs to prevent blood clots
  • Receive shots to prevent blood clots
  • Receive pain medicine through an IV or take pills. You may receive your pain medicine through a special pump. With this pump, you press a button to deliver pain medicine when you need it. This allows you to control the amount of pain medicine you get.
  • Do breathing exercises

Outlook (Prognosis)

Many people recover well from this surgery and can eat a fairly normal diet after they recover. Talk with your doctor about the best way to treat your cancer.

References

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 2/15/2013. Available at:http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/HealthProfessional. Accessed February 20, 2013.


Review Date: 2/6/2013
Reviewed By: Matthew M. Cooper, MD, FACS, Medical Director, Cardiovascular Surgery, HealthEast Care System, St. Paul, MN. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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