Esophagectomy - minimally invasive

Definition

Minimally invasive esophagectomy is surgery to remove part or all of the esophagus, 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

Description

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

Laparoscopy is one way to do this surgery:

• Your surgeon will make 3 to 4 small incisions (cuts) in your upper belly, chest, or lower neck. These cuts will be less than a ½-inch long.
• The laparoscope, with a camera on the end, will be inserted through 1 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.
• Your surgeon will close off part of your stomach with staples and cut this section off. This part of your stomach will be used to form a new section of your esophagus. It will replace the part of your esophagus that will be removed.
• Your surgeon will remove the part of your esophagus where your cancer or other problems are.
• Your 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. Your surgeon will remove them through a cut at the lower part of your neck.

Some medical centers do esophagectomies using robotic surgery. In this type of surgery, a small camera and other instruments are inserted through the small incisions. 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. See also: Robotic surgery

These surgeries usually take around 3 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:

• Pre-cancerous changes in the tissue of your esophagus. This condition is called high-grade dysplasia.
• Achalasia, a condition where the esophagus doesn’t work well

Risks

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

The risks from this surgery, or for problems after surgery, may be greater than normal if:

• You are unable to walk even for short distances. This increases the risk of blood clots, lung problems, and pressure sores.
• You are an older child who is still growing.
• You are older than 60 to 65.
• You are a heavy smoker.

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery

Risks for this surgery are:

• 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 this 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 the 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 the surgery. Your doctor or nurse for can help.

Always tell your doctor or nurse:

• If you are or might be pregnant
• What drugs, 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 1 or 2 drinks a day.

During the week before your surgery:

• You may be asked to stop taking drugs 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 drugs you should still take on the day of your surgery.
• Prepare your home for after the surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

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. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 41.