What is Esophagectomy? Purpose, Procedure & Recovery

An esophagectomy is a surgical procedure to remove part or all of your esophagus, the tube that carries food from your throat to your stomach. This surgery is most commonly performed to treat esophageal cancer, but it can also help with other serious conditions that affect your ability to swallow safely.

While the thought of this surgery might feel overwhelming, understanding what it involves can help you feel more prepared and confident about your treatment journey. Your surgical team will guide you through every step of the process.

What is esophagectomy?

Esophagectomy involves surgically removing the diseased portion of your esophagus and reconnecting the remaining healthy tissue. Think of it as replacing a damaged section of pipe in your body's plumbing system.

During the procedure, your surgeon will remove the affected part of your esophagus and then pull up your stomach or use part of your intestine to create a new pathway for food to reach your stomach. This reconstruction allows you to continue eating and drinking normally after recovery.

The surgery can be performed using different approaches, including open surgery through your chest or abdomen, or minimally invasive techniques using small incisions and specialized cameras. Your surgeon will choose the best approach based on your specific condition and overall health.

Why is esophagectomy done?

Esophagectomy is primarily recommended when you have esophageal cancer that needs to be removed completely. This surgery offers the best chance for long-term survival when the cancer is caught early enough to be surgically removed.

Beyond cancer, this surgery can help with severe gastroesophageal reflux disease (GERD) that hasn't responded to other treatments and has caused serious damage to your esophagus. Sometimes, long-term acid reflux can create scarring that makes swallowing difficult or dangerous.

Your doctor might also recommend esophagectomy for Barrett's esophagus with high-grade dysplasia, a condition where acid reflux has changed the cells lining your esophagus in ways that could become cancerous. Other rare conditions that might require this surgery include severe injury to the esophagus or certain benign tumors that can't be removed any other way.

What is the procedure for esophagectomy?

The esophagectomy procedure typically takes 4 to 8 hours, depending on the complexity of your case. You'll receive general anesthesia, so you'll be completely asleep throughout the surgery.

Your surgeon will use one of several approaches to reach your esophagus. The most common techniques include making incisions in your chest and abdomen, or sometimes just in your abdomen. Some surgeons use minimally invasive methods with smaller incisions and robotic assistance.

Here's what happens during the main steps of surgery:

1. Your surgeon carefully removes the diseased portion of your esophagus
2. Nearby lymph nodes are also removed to check for cancer spread
3. Your stomach is reshaped into a tube and pulled up to connect with the remaining esophagus
4. If your stomach can't be used, part of your large intestine may be used instead
5. The new connection is carefully tested to ensure it's secure

After the reconstruction, your surgeon will place temporary drainage tubes to help your body heal properly. These tubes typically stay in place for several days to a week after surgery.

How to prepare for your esophagectomy?

Preparing for esophagectomy involves several important steps to help ensure the best possible outcome. Your medical team will guide you through each preparation phase over the weeks before your surgery.

Your doctor will likely recommend that you stop smoking at least 2-4 weeks before surgery, as smoking significantly increases your risk of complications. If you drink alcohol regularly, you'll also need to stop drinking before the procedure.

Nutritional preparation is crucial since eating will be challenging after surgery. Your healthcare team might recommend:

• Meeting with a nutritionist to optimize your nutrition before surgery
• Taking vitamin and mineral supplements
• Eating a high-protein diet to support healing
• Gaining weight if you're underweight
• Learning about post-surgery dietary changes

You'll also need to complete several medical tests, including blood work, heart and lung function tests, and imaging studies. Some people may need breathing exercises or physical therapy to strengthen their lungs and body before surgery.

How to read your esophagectomy results?

After esophagectomy, your surgeon will discuss the findings with you once the removed tissue has been examined by a pathologist. This examination provides crucial information about your condition and helps guide your future treatment.

If you had surgery for cancer, the pathology report will tell you the stage of the cancer, whether it had spread to nearby lymph nodes, and if the surgeon was able to remove all visible cancer tissue. Clear margins mean the surgeon removed all the cancer they could see.

Your surgical team will also monitor your recovery progress through various measures. These include how well you're healing, your ability to swallow liquids and eventually solid foods, and whether you're maintaining proper nutrition.

Recovery milestones typically include starting with clear liquids, progressing to soft foods, and eventually returning to a modified regular diet. Your team will track your weight, energy levels, and overall strength as you heal.

How to recover from esophagectomy?

Recovery from esophagectomy is a gradual process that typically takes several months. Most people spend 7-14 days in the hospital after surgery, where your medical team will closely monitor your healing and help you begin eating again.

Your eating habits will change significantly after this surgery. You'll need to eat smaller, more frequent meals and chew your food very thoroughly. Many people find they feel full much more quickly than before surgery.

During your recovery, you can expect to experience some common changes:

• Feeling full after eating small amounts
• Needing to eat 6-8 small meals per day instead of 3 large ones
• Taking longer to eat meals
• Avoiding drinking liquids with meals
• Sleeping with your head elevated to prevent reflux

Physical activity will gradually increase as you heal. You'll start with gentle walking and breathing exercises, then slowly return to more normal activities over 6-8 weeks.

What are the risk factors for esophagectomy complications?

Several factors can increase your risk of complications from esophagectomy. Age is one consideration, as people over 70 may have a higher risk of certain complications, though many older adults do very well with this surgery.

Your overall health plays a significant role in your surgery outcome. Heart disease, lung problems, diabetes, and kidney disease can all affect your recovery. However, your surgical team will work to optimize these conditions before your procedure.

Lifestyle factors that can increase your risk include:

• Current smoking or recent smoking history
• Heavy alcohol use
• Poor nutritional status or significant weight loss
• Previous chest or abdominal surgery
• Certain medications that affect healing

Your surgeon will carefully evaluate all these factors and work with you to minimize risks wherever possible. Many risk factors can be improved before surgery with proper preparation.

What are the possible complications of esophagectomy?

While esophagectomy is generally safe when performed by experienced surgeons, it's important to understand the potential complications so you can make an informed decision about your treatment.

The most serious but rare complication is a leak at the connection site where your stomach or intestine is joined to your remaining esophagus. This happens in about 5-10% of cases and may require additional surgery or extended healing time.

More common complications that usually resolve with proper treatment include:

• Pneumonia or other lung problems (10-20% of cases)
• Irregular heart rhythm (10-15% of cases)
• Infection at the incision site (5-10% of cases)
• Blood clots in the legs or lungs (2-5% of cases)
• Temporary difficulty swallowing (most people experience this initially)

Long-term complications can include ongoing reflux, changes in how your stomach empties, or nutritional challenges. However, most people adapt well to these changes with proper support and dietary modifications.

When should I see a doctor after esophagectomy?

You'll have regular follow-up appointments with your surgical team, but it's important to know when to seek immediate medical attention. Contact your doctor right away if you experience severe chest pain, difficulty breathing, or signs of infection like fever and chills.

Problems with swallowing that suddenly get worse, persistent vomiting, or inability to keep liquids down are also reasons to call your healthcare team immediately. These symptoms could indicate a complication that needs prompt treatment.

Other warning signs that warrant immediate medical attention include:

• Severe abdominal pain that doesn't improve with pain medication
• Signs of dehydration like dizziness, dry mouth, or decreased urination
• Coughing up blood or blood in your vomit
• Redness, swelling, or drainage from your incision sites
• Leg swelling or pain that could indicate blood clots

Remember that some discomfort and eating challenges are normal after this surgery, but your healthcare team is there to help you distinguish between normal recovery and concerning symptoms.