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An esophagectomy is a surgical procedure that involves removing part of the esophagus. It is typically performed when medications and other types of non-invasive treatments have been ineffective at treating esophageal cancer or a precancerous condition called high-grade dysplasia. Depending on the size and location of the section to be removed, an esophagectomy may be performed through incisions in the neck or chest cavity. Modern imaging technology and surgical advancements allow most surgeries of the type to be performed with an endoscope rather than an invasive open procedure.
Esophageal cancers and dysplasia are relatively uncommon and medications are generally of little use in treating symptoms. A team of doctors may decide that surgery is the best way to correct problems and prevent cancer from spreading to other parts of the body. During a consultation, a patient has the opportunity to learn the details of the esophagectomy procedure and decide whether or not he or she wants to go through with it. Recovery can take several months, but the overall success rate is high.
When only the upper portion of the esophagus needs to be removed, a minimally-invasive procedure called a transhiatal esophagectomy can be performed. While the patient is under general anesthesia, a surgeon makes a small incision underneath the chin and inserts an endoscope. The endoscope relays real-time images to a computer monitor, allowing the surgeon to carefully inspect tissue and determine where to make cuts. Two or more small incisions are made in the neck and the surgeon manipulates precision instruments to clip away the cancerous portion of the esophagus. Once it has been removed, the remaining portion is connected to an artificial tube, donor tissue, or a transplanted section of the patient's large intestine.
Surgery on the lower part of the esophagus is performed similarly, though incisions are made in the chest cavity rather than the neck. After the damaged portion is removed, the surgeon staples or sutures the upper part of the stomach to the bottom of the remaining esophagus. Both types of esophagectomy can usually be performed in less than five hours.
Following surgery, a patient is carefully monitored for several days by doctors and nurses to make sure complications do not arise. He or she typically needs to stay in the hospital for at least one week to receive fluids and a specialized liquid diet. If the patient is recovering correctly, he or she can go home with instructions to rest and eat small portions of soft foods for about one month. Follow-up visits can confirm that the procedure was successful. Most people experience near full recoveries when they follow their doctors' instructions.
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