Surgical Procedures: Esophagectomy

What is an esophagectomy and how is it done?

An esophagectomy is a surgery that removes part of the esophagus. The esophagus is a tube that connects the throat to the stomach. The job of the esophagus is to move food that has been swallowed to the stomach. Sometimes, an esophagectomy will also remove a part of the stomach.

An esophagectomy may be used to treat:

• Cancer.
• Barrett’s esophagus.
• Narrowing of the esophagus caused by acid reflux, achalasia (nerve damage to the esophagus), or an injury caused by a surgery.

The extent of the esophagectomy and how much of the esophagus is removed depends on many factors, such as disease size and location. At times, the stomach or the intestine is connected to a piece of the esophagus that is left in place at the time of surgery.

There are many ways to perform an esophagectomy, including:

• Transhiatal (through the diaphragm): Incisions (cuts) are made in the belly and the neck. This allows the surgeon to reach the esophagus.
• Transthoracic (through the thoracic cavity): Incisions (cuts) are made in the belly and one side of the chest. This allows the surgeon to reach the esophagus.
• Thoracoabdominal (through the abdominal cavity): One large incision (cut) is made from the chest to the belly. This allows the surgeon to reach the esophagus.
• Minimally invasive laparoscopic esophagectomy: Many small incisions (cuts) are made, allowing for the insertion of surgical tools and a lighted camera, which are used during the procedure.

During any of these types of esophagectomy, lymph nodes may also be removed to check for possible spread of cancer.

What are the risks of having an esophagectomy?

There are risks and side effects linked to having an esophagectomy. Risks and side effects may be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Bleeding.
• Blood clots.
• Injury to the spleen and/or trachea.
• Infection.
• Pneumonia.
• Voice changes.
• Leaking at the site of internal stitches (stitches on the inside of your body) that connect one organ to another. This connection is also called an anastomosis.
• Leaking of a type of lymphatic fluid called chyle.
• Trouble with swallowing because of narrowing of the esophagus.
• Delayed gastric emptying (slow digestion).
• Heartburn.

Your surgeon and healthcare team will talk with you about the possible risks of your procedure.

What is recovery like?

Recovery from an esophagectomy depends on which procedure you have had. At times, a long hospital stay is needed. During surgery, a feeding tube will be put into your belly and will be used for about 1 to 2 months. This feeding tube will give you nutrition and medication if needed as you heal.

You will be told how to care for your incisions and will be given any other instructions before leaving the hospital.

Your healthcare team will teach you about the medications you will be taking, such as those for pain, and prevention of blood clots, infection, constipation, and/or other conditions.

Your provider will talk to you about activities you should avoid doing. In general:

• Your provider will tell you for how long you shouldn’t lift heavy objects.
• Rest as needed and do not do any movements that cause pain.
• Hold a pillow over your surgical incisions (if large) when coughing or sneezing.
• Avoid tub bathing, hot tubs, and/or swimming pools until your healthcare team says it is okay.
• Change your diet as directed by your healthcare team.
• Speak with your healthcare provider about when it is safe for you to drive, go back to your normal activities, and go back to work.

What will I need at home?

• A thermometer to check for fever, which can be a sign of infection.
• Wound care supplies, which will likely be given to you when you leave the hospital or in your surgeon’s office.

Contact your healthcare provider if you have:

• Fever. Your team will tell you at what temperature they should be called.
• Any new or worsening pain.
• A hard time breathing and/or a cough that doesn’t go away.
• Trouble eating or drinking, or if you have nausea or vomiting after eating.
• Diarrhea or loose bowel movements.
• Yellowing of the skin or whites of your eyes.
• Burning in the throat when laying down or during sleep.
• Symptoms of dumping syndrome, such as:
  • Stomach cramping.
  • Stomachache.
  • Lightheadedness.
  • Dizziness.
  • Nausea, and/or diarrhea within 20 minutes of eating.
  • Sweating and/or a rapid heartbeat.
  • Bleeding, warmth, drainage or redness at the incision.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.