Esophagectomy

Transhiatal esophagectomy is the most common type of esophageal cancer surgery we perform. This approach involves only a neck incision.

During a transhiatal esophagectomy, we:

1. Remove most of your esophagus and a little bit of your stomach
2. Bring the rest of your stomach up to your neck and attach it to the remaining esophagus

Ivor Lewis esophagectomies are the second most common type of esophagectomy we perform. This approach involves incisions in the abdomen and chest. During this procedure, we:

1. Remove part of your esophagus
2. Make a tube (conduit) out of part of the stomach
3. Connect the stomach conduit to the esophagus in your chest

The thoracoabdominal approach is the least common. We use it when a tumor is in your lower esophagus or gastroesophageal (GE) junction (where your esophagus joins your stomach).

During this procedure, we:

1. Make an incision in your abdomen that goes to the left side of your chest
2. Divide your esophagus in the left chest
3. Bring either your stomach or small intestine up to your left chest to create a new connection

It is incredibly important to maintain your nutrition before your esophagectomy. You’ll work with your esophageal cancer team, including a registered dietitian, to ensure you’re maintaining adequate nutrition. If you are able to eat and swallow, you will be placed on a modified, high-protein diet and supplements. The goal is to maintain your weight as much as possible throughout treatment.

If you are a smoker, you must quit smoking as part of your surgical preparation, because smoking greatly increases the risk of complications during and after surgery. We offer a comprehensive smoking cessation program to help you quit.

During your recovery, the goal is to get you back to eating both for pleasure and for nourishment. Normally, your stomach is a passage organ. After a big meal, food churns in your stomach for a couple of hours and is digested. After your esophagus is removed and rebuilt with your stomach or colon, you are advised to eat seven smaller meals each day. This is because if you eat a lot, you will feel full much more quickly. After your esophagectomy, you can still enjoy many of the foods you love; you’ll just have to eat smaller meals, more frequently than the standard three large meals each day.

An esophagectomy is a big operation, even when it uses a minimally invasive approach. The surgery crosses two or three body cavities — abdomen, chest and neck — and routinely takes four to six hours.

After your procedure, you’ll likely be able to get out of your hospital bed and walk around within about 48 hours. The general length of stay after an esophagectomy is about eight days. You’ll be discharged from the hospital with a feeding tube placed.

Generally, your feeding tube will stay placed for six to eight weeks. However, several factors, including the need for post-operative chemotherapy, can affect how long you have a feeding tube. Three weeks after surgery, you’ll undergo a swallow study. If the connection is healed, you’ll advance your diet. Once you are cleared to swallow, you’ll go through about a 10-day diet transition from clear liquids, to full liquids, to soft foods.

Yes. Regular aerobic exercise is an important component of esophagectomy preparation. When you are in your best possible physical condition before surgery, it is more likely that you will experience a quicker and easier recovery after surgery.

If you are malnourished because your symptoms make it impossible for you to swallow, you will likely have a feeding tube placed before you undergo chemotherapy, radiation therapy or surgery. If you are undernourished, we may not be able to treat you.