Esophagectomy

Surgery Details

Mayo Clinic provides care in a multidisciplinary setting where teams of specialists coordinate the treatment of esophageal disorders. Specialists from gastroenterology, thoracic surgery, radiation oncology, medical oncology, and other areas work together closely to provide high-quality care for patients with these complex and challenging conditions. Concurrent chemoradiation may be given either before or after surgical removal of a cancer depending on the initial extent of the cancer (based on preoperative imaging or postoperative pathological examination of the surgical specimen).

Before Surgery

Mayo Clinic patients who have been found to be good candidates for an esophagectomy meet with members of the specialized team that will be assisting in their care. They receive instructions to help prepare for the surgery. Information about eating, drinking and taking medications before the surgery is explained. Patients meet with their anesthesiologist, nurse clinician, gastroenterologist and surgeon and are encouraged to ask questions about the surgery and anything relating to their experience at Mayo Clinic.

In addition:

• A cardiac catheterization may be done to check for coronary artery disease or other forms of cardiovascular disease that could complicate surgery.
• Beyond the tests that were used to diagnose Barrett's esophagus or esophageal cancer, other basic diagnostic tests include blood tests, an electrocardiogram and a chest x-ray which are required before surgery.

The need for more specialized tests is determined on an individual basis.

During Surgery

The total time in the operating room is approximately three hours, but each person is unique, and it's not unusual for the surgery to fall in the range of five to eight hours.

The surgeon makes four to five small incisions, and inserts tubelike instruments through them. The abdomen is filled with gas to help the surgeon view the abdominal cavity. A camera inserted through one tube displays images on a monitor located in the operating room. Other instruments are be placed through additional tubes, allowing the surgeon to work inside the abdomen without using a larger incision. After the stomach is exposed, the upper portion (fundus) is stapled off and cut from the rest of the stomach.

The second part of the procedure is the thorascopic stage. Instruments are inserted into the chest to remove the damaged parts of the esophagus. After the fundus and lower esophagus are free, both are removed. To re-establish continuity of the digestive tract, the stomach is pulled upward to join with the remaining portion of the esophagus.

Immediately Following Surgery

Patients are in the hospital an average of eight days. Patients are in the intensive care unit for about one day, and are then moved to a regular hospital unit.

A nursing unit dedicated to thoracic surgery cases provides patients with postoperative care. Additional services available to esophageal cancer patients include:

• Psychosocial care
• Pulmonary rehabilitation
• Nutritional assessment
• On-site patient education
• Pain management

After Leaving the Hospital

Because a laparoscopic procedure is less traumatic, patients usually resume normal activities soon after leaving the hospital. After a month, patients can resume their normal diet, but need to eat smaller quantities. The reduced size of the stomach limits its capacity to hold food. Instead of eating three large meals, many people choose to eat several small meals each day. Most patients can expect to lose about 20 pounds after surgery.

Follow-Up Care

Mayo Clinic staff works with patients and their local physician to assist with a full and smooth recovery following surgery.

Complications

As with any surgery, risks can include bleeding, infection or an adverse reaction to anesthesia. There is also the potential of breathing problems.

Mortality for patients undergoing the procedure averages about 3 to 5 percent, with the largest majority of complications affecting patients age 65 and over and those with other serious medical conditions prior to the surgery.