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Esophagectomy - open

Definition

An esophagectomy is surgery to remove part or all of the esophagus, the tube that moves food from your throat to your stomach. After it is removed, the esophagus is rebuilt from part of your stomach or part of your large intestine.

Most of the time, esophagectomy is done to treat cancer of the esophagus.

Alternative Names

Trans-hiatal esophagectomy; Trans-thoracic esophagectomy; En bloc esophagectomy; Removal of the esophagus - open

Description

There are many ways to do this surgery. Talk with your doctor about what type of surgery is best for you. It will depend on where in your esophagus your cancer is, how much it has spread, and how healthy you are.

Laparoscopy is one way to do this surgery. A laparoscope is a tiny camera that is inserted into your belly through a small incision. See also: Esophagectomy - minimally invasive

Open surgery is another way to do an esophagectomy. Two ways to do an esophagectomy using open surgery are:

Trans-hiatal esophagectomy:

• Your surgeon will make 2 large incisions (cuts), one in your neck area and one in your upper belly.
• Your surgeon will close off part of your stomach with staples and cut this section off. This part of your stomach will be used to form a new section of your esophagus. It will replace the part of your esophagus that will be removed.
• Your surgeon will remove the part of your esophagus where your cancer or other problems are.
• Your surgeon will join together your rebuilt esophagus and stomach in your neck.
• Lymph nodes in your neck and chest may also be removed if your cancer has spread to them.

Trans-thoracic esophagectomy:

• Your surgeon will make 2 incisions, one in your chest and one in your upper belly.
• Your surgeon will close off part of your stomach with staples and cut this section off. This part of your stomach will be used to form a new section of your esophagus. It will replace the part of your esophagus that will be removed.
• Your surgeon will remove the part of your esophagus where your cancer or other problems are.
• Your surgeon will join together your rebuilt esophagus and stomach in your neck.
• Lymph nodes in your neck and chest may also be removed if your cancer has spread to them.

Your surgeon may also examine and do a biopsy of the lymph nodes in your belly to see if your cancer has spread to them.

En bloc esophagectomy is another type of esophagectomy. It is the most invasive of all of these procedures.

• To do it, your surgeon will make large cuts in your chest and belly. All of your esophagus and part of your stomach will be removed.
• The rest of your stomach will be reshaped and placed in your chest to replace your esophagus.
• Your surgeon will also remove all lymph nodes in your chest and belly.

Most of these operations take about 3 hours.

Risks

Esophagectomy is major surgery and has many possible risks. Some of them are serious. You should discuss these risks with your surgeon.

The risks from this surgery, or for problems after surgery, may be greater than normal if:

• You are unable to walk even for short distances. This increases the risk of blood clots, lung problems, and pressure sores.
• You are an older child who is still growing.
• You are older than 60 to 65.
• You are a heavy smoker.

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery

Risks for this surgery are:

• Injury to the stomach, intestines, lungs, or other organs during surgery
• Leakage of the contents of your esophagus or stomach where the surgeon joined them together
• Narrowing of the connection between your stomach and esophagus

Review Date: 2/17/2009
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.