Open Esophagectomy

An open esophagectomy, or esophageal resection, is a type of surgery in which a part of the esophagus or the entire esophagus is removed. The lymph nodes near the esophagus and the stomach may also be removed during this operation.

The esophagus is a hollow muscular tube that passes food from your mouth to your stomach during digestion. A connection has to be rebuilt when any part of the esophagus is removed.

An open esophagectomy doesn’t refer to a single type of procedure. It can be performed by many different methods. The method used depends on both your needs and the surgeon’s experience. An open esophagectomy can also be part of a treatment for cancer of the esophagus that includes radiation and chemotherapy.

An open esophagectomy is frequently performed to treatearly-stage cancer of the esophagus before the cancer has spread to the stomach or other organs. It can also be used to treat esophageal dysplasia, which is a precancerous condition of the cells in the lining of the esophagus.

In the majority of people who need an open esophagectomy, cancer has already spread to the lymph nodes, stomach, or other organs.

An open esophagectomy might also be performed if you have other conditions that make the passage of solid food and liquids into the stomach uncomfortable. Conditions requiring this procedure include:

  • trauma to the esophagus
  • swallowing of caustic, or cell-damaging, agents such as lye
  • chronic inflammation
  • complicated muscle disorders that prevent the movement of food to the stomach
  • a history of unsuccessful surgery on the esophagus

The procedure is performed in a hospital or clinic operating room with a general or thoracic surgeon.

There are three types of open esophagectomies that a surgeon might perform:

Transthoracic Esophagectomy (TTE)

A TTE is performed through the chest. The section of the esophagus with cancer and the upper part of the stomach are removed. The remaining portions of the esophagus and stomach are then connected to rebuild a digestive tract. In some cases, part of the colon is used to replace the removed section of esophagus. Lymph nodes in the chest or neck may also be removed if they’re cancerous.

A transthoracic esophagectomy (TTE) is used for:

  • cancer involving the upper two-thirds of the esophagus
  • dysplasia in a condition called Barrett’s esophagus
  • destruction of the lower two-thirds of the esophagus by swallowing a caustic agent
  • complications of reflux esophagitis that couldn’t be improved with other procedures

Transhiatal Esophagectomy (THE)

During a transhiatal esophagectomy (THE), the esophagus is removed without opening the chest. Instead, an incision is made from the bottom of the breastbone to the bellybutton. Another small incision is made on the left side of the neck. The surgeon removes the esophagus, moves the stomach up to the area in the neck where the esophagus was removed, and connects the remaining portion to the stomach in the neck. Lymph nodes in the chest or neck may also be removed if they’re cancerous.

A transhiatal esophagectomy (THE) is used to:

  • remove cancer of the esophagus
  • remove the esophagus after other procedures have been used to treat cancer of the esophagus
  • narrow or tighten the esophagus to make swallowing less difficult
  • correct problems with the nervous system
  • repair recurrent gastroesophageal reflux
  • repair a hole or injury caused by a caustic agent such as lye

En Bloc Esophagectomy

An en bloc esophagectomy is the most radical of the esophagectomy procedures. During this procedure, your doctor takes out the esophagus, a portion of the stomach, and all of the lymph nodes in the chest and abdomen. The surgery is performed through the neck, chest, and abdomen. Your doctor will reshape the remainder of the stomach and bring it up through the chest to replace the esophagus.

A radical en bloc esophagectomy is used to treat a potentially curable tumor.

Before your surgery, your doctor will:

  • give you a complete physical examination
  • make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control
  • give you nutritional counseling
  • review what you can expect during and after the surgery, and what risks and complications may result from the operation
  • review what medication you’ll need to take or stop taking before surgery
  • give you advice on how to quit smoking at least a few weeks before your surgery

You must take some important steps before your surgery is scheduled. For example, don’t take any medications that affect blood clotting. Examples include:

  • ibuprofen (Motrin, Advil)
  • products containing aspirin
  • vitamin E
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Don’t smoke cigarettes for at least four weeks before your operation. You may be tested the day of your operation to make sure you haven’t been smoking. If you have, your operation may be canceled.

Walk between 2 and 3 miles a day to get in the best shape possible.

The Day of Surgery

Don’t eat or drink anything after midnight the night before your surgery. Take any medication your doctor instructed you to take, with a small sip of water only.

This surgery is performed under general anesthesia. This means you’ll be asleep during surgery. Your anesthesiologist may ask you about your medical history to be sure you haven’t had a reaction to anesthesia in the past.

As with any surgery, the possible complications include:

  • bleeding
  • blood clots in the legs that may travel to the lungs
  • an infection
  • a bad reaction to anesthesia
  • leakage problems
  • breathing problems
  • a heart attack during surgery
  • a stroke during surgery

Complications specific to an open esophagectomy include less common risks of:

  • lung complications, especially pneumonia
  • a severe infection in the chest
  • an injury to the stomach, intestines, lungs, or other organs during surgery
  • a leakage from your esophagus or stomach where the surgeon joined them together
  • a narrowing of the connection between your stomach and esophagus

You’ll wake up after the operation with a number of tubes and catheters that help monitor your condition. These may include:

  • a nasogastric tube to remove fluids from your stomach
  • a feeding jejunostomy tube to provide nutrition during your hospital stay and until you can eat on your own
  • a chest tube to drain fluids that often form in the chest after surgery
  • an epidural catheter, which is placed in the space around your spine to deliver pain medication when you need it
  • a Foley catheter to drain your urine for the first few days after surgery

People usually stay in the hospital between one and two weeks following the procedure. There will be a scar where the incisions were made.

An open esophagectomy can have good results and can lead to a good quality of life in the long term. Rates of death following surgery, or mortality rates, have significantly decreased over the past two decades.

Return to Normal

You can usually return to normal activities about three weeks after surgery. You may be back to your regular diet after a month. However, the reduced size of your stomach will limit how much you can eat. Therefore, you’ll need to eat smaller amounts.

Dumping Syndrome

Your ability to digest fats and sugars will change. This can lead to something called dumping syndrome. In dumping syndrome, cramping and diarrhea occur as your body tries to get rid of food it no longer recognizes.

A dietician can help you work out your meal options to control the symptoms of dumping syndrome.

Your diet may be the hardest part to adjust to after your surgery, and you may lose weight. However, most people adjust to the changes in their body and new diet about four to six months after the surgery.