An esophagectomy, the surgical removal of all or part of the esophagus, is a major surgery for the treatment of esophageal cancer and certain advanced benign diseases of the esophagus. AHN surgeons specialize in a minimally invasive approach to esophagectomy. Through the course of your evaluation, an individualized multidisciplinary treatment plan is created to support you throughout your treatment. The AHN Esophageal and Gastric Center of Excellence is designed to support your needs through comprehensive and focused care. We see you and your unique needs and are here to help you navigate this procedure.
Reasons for an esophagectomy may include:
AHN has a team of surgeons with specific expertise in esophageal surgery that are board-certified in general surgery or surgical oncology. We are a high-volume center with extensive experience performing esophagectomies and specialize in cancerous and benign diseases of the esophagus.
At AHN, you can expect:
Your AHN care team will give you specific instructions to help you prepare for an esophagectomy. Prior to surgery, your doctor will perform the necessary medical tests, which may include a physical exam, blood test, and imaging studies. You may also undergo cardiopulmonary testing to assess your fitness for surgery.
This surgery is done in a hospital setting where you will be cared for before and after the procedure. To prepare, you will meet with your doctor to discuss the preparation for surgery. This may include taking certain medications, quitting smoking or drinking, and discussing any other lifestyle modifications that will help you before, during, and after surgery. You will also be given instructions on what you should eat or drink the night before your surgery. You will be given special soap to use before surgery.
On the day of surgery, it is helpful to have someone with you who can stay for the duration of the surgery and then be with you post-op to help get you home. Your care team will meet with you prior to your surgery to discuss what to expect before, during, and after surgery. A multidisciplinary team, including surgeons, gastroenterologists, pulmonologists, cardiologists, nutritionists, and other health care professionals, often are involved to ensure your whole health is monitored and supported.
The esophagus is removed through incisions in the neck and abdomen, without opening the chest. The surgeon works through the abdominal and neck incisions to carefully dissect and remove the esophagus. This is done "blindly" (without direct visualization) in the chest, relying on tactile feedback and experience. The stomach is mobilized and pulled up through the esophageal hiatus (the opening in the diaphragm where the esophagus passes) into the neck. The anastomosis (connection) between the stomach and the remaining esophagus is performed in the neck.
Lymph node dissection is performed in the abdomen and neck. Because there is no incision in the chest, a complete, formal mediastinal lymph node dissection (lymph nodes in the middle of the chest) is not performed.
The primary advantage is avoiding a chest incision (thoracotomy). This can lead to potentially less postoperative pain, reduced risk of pulmonary complications (e.g., pneumonia), and a potentially shorter hospital stay. However, the "blind" dissection in the chest can be technically challenging and may not be suitable for all tumors, especially those that are large or have spread to surrounding structures.
The typical patient experience may include:
Also called a transthoracic esophagectomy, the esophagus is removed through incisions in the chest and abdomen. This approach uses small incisions on the abdomen and chest to complete the surgery.
The surgeon works through both incisions. The abdominal incision is used to mobilize the stomach, while the thoracic incision provides direct access to the esophagus in the chest for removal. The stomach is pulled up into the chest, and the anastomosis (connection) between the stomach and the remaining esophagus is performed in the chest.
Lymph node dissection is performed in the abdomen and chest. This approach allows for a more extensive lymph node retrieval than the transhiatal approach. This approach can be used for tumors in the lower and mid-esophagus.
Typical patient experience may include:
Also called a three-hole esophagectomy, the procedure Involves incisions in the neck, abdomen, and chest. The esophagus is mobilized from the abdomen and chest incisions. A cervical esophagogastric anastomosis (connection) is performed in the neck.
The stomach is pulled up through the chest to the neck, and the anastomosis (connection) between the stomach and the remaining esophagus is performed in the neck. This is a cervical anastomosis.
The surgeons dissects (removes) lymph nodes in the abdomen, chest, and neck. This approach offers a comprehensive lymph node dissection, which can be beneficial for tumors with a high risk of lymph node involvement. This approach is best used for tumors that are higher in the esophagus.
A typical patient experience may include:
Recovery for an esophagectomy will be different for each patient and yours will be supported by your team at AHN. Your recovery will focus on improving strength and activity, supporting your nutrition by mouth, and comprehensive pain control. AHN has a multidisciplinary team that includes physical therapists, dietitians, and physicians who can help with this process.
AHN is here to help you through the recovery process and manage any symptoms or side effects.
If you notice any of the following, contact your health care provider:
An esophagectomy is a major surgery that will bring about emotions, potential concerns, and questions. AHN is here to help you feel confident in your care plan and get all your questions answered. If you are feeling overwhelmed and don’t know where to start, these frequently asked questions are a good place to begin. From there, your AHN care team is ready and able to talk with you about whatever is on your mind.
Yes, an esophagectomy is considered a major surgery. It involves removing all or part of the esophagus, which is a significant and complex procedure. It typically requires a hospital stay and a recovery period.
Life expectancy after an esophagectomy varies significantly depending on several factors. These include the stage of the cancer (if the surgery was for cancer), the patient's overall health, and the success of the surgery and any follow-up treatments. It's best to discuss individual prognosis and life expectancy with your doctor, who can consider your specific situation.
Eating will likely be different after an esophagectomy. The stomach is often used to replace the removed esophagus, which can affect how quickly food passes through your system. You may need to eat smaller, more frequent meals and avoid certain foods that cause discomfort. Over time, many patients can adapt and enjoy a relatively normal diet, but it requires adjustments and careful attention to your body's signals.
Drinking alcohol after an esophagectomy is generally discouraged. Alcohol can irritate the stomach and esophagus (or the reconstructed area), potentially causing discomfort or complications. It's best to discuss alcohol consumption with your doctor to understand the specific risks and recommendations for your situation.
After the esophagus is removed, the surgeon will reconstruct the digestive tract. Typically, this involves using a portion of the stomach to create a tube that is then connected to the remaining esophagus or the throat. In some cases, a section of the colon may be used instead. This new connection allows food to pass from the mouth to the stomach. You will likely need to stay in the hospital for a period to recover and learn how to eat and manage any potential complications.
Please call (412) DOCTORS (412) 362-8677 to schedule a esophagectomy.
