What Is an Esophagectomy?
Esophagectomy is a major surgical procedure that removes part of the esophagus. The esophagus is the tube through which food travels from your mouth to your stomach.
Minimally invasive esophagectomy (MIE) is a treatment for esophageal cancer. Usually, the surgery treats cancer that has not spread to other areas of the body. In some patients, the entire esophagus is removed, while others just have a portion removed. A new “food tube” is created from part of your stomach after esophagectomy.
“Minimally invasive” means that one or more small incisions are made for inserting one or more tubes. These tubes allow the doctor to insert specially designed surgical tools and tiny cameras. Compared to open surgery, a minimally invasive surgery:
- causes less blood loss
- creates smaller incisions
- allows for more rapid recovery
Reasons for Minimally Invasive Esophagectomy
Esophagectomy is used primarily to treat cancer. Other medical conditions that can require surgery are:
- Barrett’s esophagus (the esophagus lining is damaged by stomach acid and becomes like stomach lining)
- trauma to the esophagus from accident or injury
- nerve and muscle damage to the esophagus
Your doctor may decide to remove your esophagus either before or after chemotherapy and radiation treatments. The timing of your surgery depends on your overall health and the specifics of your condition.
Preparing for Minimally Invasive Esophagectomy
Preparation for your procedure begins several weeks beforehand. You will undergo medical testing to control any additional health conditions like high blood pressure and diabetes.
You should stop smoking a few weeks before your surgery. Let your doctor know if you need help quitting. Smoking cessation aids can include gum, patches, oral medication, and support groups.
Stop taking blood-thinning medications and drugs containing aspirin at least seven days before your MIE. This reduces your risk of bleeding during the operation.
Do not eat or drink anything after midnight before your surgery.
MIE is performed under general anesthesia, meaning you will be asleep during the surgery and unable to feel pain.
Minimally Invasive Esophagectomy Procedure
A technique called laparoscopy is used in an MIE. In a laparoscopy, the surgeon makes very small incisions and uses thin, flexible instruments to remove part (or all) of the esophagus.
The surgeon will make three or four half-inch long incisions in your stomach area, upper chest, and neck. A laparoscope, an instrument with a tiny camera on the end, is inserted into one of the incisions. The camera lets the doctor see the inside of your body on a monitor. The doctor will insert other surgical instruments into the other holes to perform the esophagectomy.
After the diseased area of the esophagus is removed, your stomach will be divided with surgical staples. A piece of your stomach will be removed and reconstructed into a new esophagus. The doctor will connect the new esophagus to the rest of your stomach, and will place a feeding tube in your intestines. You will be fed through the tube while your stomach and esophagus heal.
Even though this type of operation is minimally invasive, it is still major surgery. The average MIE can take anywhere from three to six hours.
Some MIEs are performed with the help of a computer program. This type of procedure is called “robotic surgery.”
The first one to three days after minimally invasive esophagectomy are usually spent in the intensive care unit (ICU). Once your blood pressure, breathing, and heart rate are stable, you can move to a regular room. You will be asked to sit up and walk around on the same day as your surgery to help prevent blood clots.
Most people stay in the hospital for up to two weeks following MIE. You will use the feeding tube for two to three days. After the feeding tube is removed, you can begin to eat real foods again. You will probably start with a soft or liquid diet and progress slowly toward eating solid foods again.
Your doctor will prescribe pain medications to control your discomfort.
Risks and Complications
The development of blood clots, heart attack, stroke, blood loss, and infection are risks with any kind of major surgery. Anesthesia, which is required for this procedure, comes with its own risks as well, including breathing difficulties and the potential for allergic reactions.
Risks particular to MIE include injury to internal organs (lungs, intestines, stomach, or other organs) and development of acid reflux. The narrowing of the newly created esophagus is a rare but potentially serious risk as well. Additionally, it is possible that, during surgery, the division of the stomach and the new esophagus may also leak fluids. These risks should be discussed with your surgeon beforehand.
The outlook for MIE is good. The University of Pittsburgh Medical Center estimates a mortality rate of less than two percent (University of Pittsburgh Medical Center). Many people who undergo this type of procedure can continue to follow a normal diet. However, acid reflux is a common side effect. You may need to adjust your diet to include low-acid foods.