Thoracic Oncology Program

Esophageal Cancer

Surgical Staging

One of the best indicators of the extent of cancer are the lymph nodes. Lymph nodes are tiny glands that help the body fight infection and tumor. The stage of cancer is determined by the size of the tumor and the number and location of enlarged lymph nodes.

Accurate staging helps tailor treatment to your specific need. Most patients with esophageal cancer at UMMS undergo conventional non-invasive staging as well as surgical staging, in order to more clearly define the extent of the cancer.

Surgical staging involves two procedures - thoracoscopy and laparoscopy. These procedures are performed during one operation and provide exact reports of the extent of your tumor and the number and location of lymph nodes that have been affected by cancer.

Thoracoscopy

A minimally invasive technique. Three small (approximately 1 inch) incisions are made in your side between your ribs. A video-scope is placed through one of the incisions. This scope allows the surgeon to see inside your chest and inspect your lungs and esophagus. The surgeon will sample lymph nodes in your chest during this procedure. The incisions are then closed by sutures, which will eventually dissolve.

Laparoscopy

Also a minimally invasive technique. Three or four small (less than 2 inch) incisions are made in your abdomen. Optical instruments will be used to examine the insede of your abdomen, including your stomach, esophagus and lymph nodes. The surgeon will sample the lymph nodes in your abdomen during this procedure. The incisions are closed by sutures, which will eventually dissolve.

Mediport

If you will be receiving chemotherapy, you may have a mediport placed during the operation. The port will be under your skin. This will allow easy IV access for chemotherapy and future blood drawing. The mediport is temporary. It will remain in until a month or more after your esophagectomy. The mediport will need to be flushed periodically (once a week while it is in use, once a month when it is not being used). During your chemotherapy and radiation therapy, this can be done when your blood is drawn to check your blood cell count. At other times, we can arrange for a nurse to come to your home.

Feeding Tube

Depending on your nutritional status and the location of your tumor, your surgeon may need to place a feeding tube during the staging operation. This will help keep your body in optimal condition during your subsequent treatments. The feeding tube is temporary and will be removed about a month after your esophagectomy.

Risks

The main risks of thoracoscopy surgery are: prolonged air leak, pneumonia or infection, bleeding, need for a blood transfusion, stroke, heart attack and death.

Prolonged air leak

No matter which approach is used, one or more chest tubes will be placed in your side during the operation. These tubes drain fluid and air from around the lungs. Most patients have an air leak after lung surgery. This happens when air from the lung tissue (usually at the internal suture line) leaks out into the chest cavity. If the volume of air inside the chest becomes too great, the pressure could cause the lung tissue to collapse. The chest tubes prevent this from happening. Most air leaks stop within 3 to 5 days after surgery. When they last longer, it is called a prolonged air leak. This is the most common complication of chest surgery. These leaks always heal, but it can mean you will need to stay in the hospital longer than expected.

Postoperatively

Expect to stay approximately 3 to 5 days on the cardiothoracic surgery unit. Once there is no longer air leaking from your chest tubes, they will be removed and you will be able to go home. Your family can visit you between the hours of 11am and 8pm.

Chest Tubes

During surgery, one or more chest tubes will be placed into your side. These chest tubes are used for drainage and to monitor air leakage. The tube is hooked up to an empty container, which will collect any fluid that drains out from your chest. The chest tube will remain in until the drainage stops and there is no air leakage.

Pain Control

Operations create pain. We make every effort to minimize your discomfort through oral medications and IV medications. You will be asked frequently about your pain. Please be honest. It is very important for the pain to be under control because taking deep breaths and moving are essential for quick recovery.

Oral medications are most often given on an "as needed" schedule. This means that you must ask the nurse to give you the medicine. Usually, there is a 4 hour interval between doses. Please let your nurse know if you need your medicine more frequently or if it make you too sleepy.
PCA (Patient Controlled Analgesia): This is pain medicine that is given through your IV. You will be able to press a button connected to the pain medicine and dose yourself as needed. You do not need to worry about overdosing or becoming addicted. Limits will be programmed into the pump and you will not become dependent while you are having real pain.

Deep Breathing, Coughing & Incentive Spirometry

It is very important to cough and deep breath after surgery. Your lungs need to be fully expanded to prevent infection and collapse. Please practice coughing and deep breathing before you come in for surgery.

Deep breathing: fill you lungs up slowly over a count of 5, hold for a count of 5, exhale slowly over a count of 5. REPEAT 10 TIMES per hour while you are awake.
Coughing: take two slow breaths filling your lungs up as much as possible. Begin your cough as you exhale the second time. Make sure you hold a pillow or towel over your incision (also called "splinting" your incision) during your cough. This will decrease the pain. REPEAT 10 TIMES per hour while you are awake.
Incentive Spirometry: Hold the spirometer securely in two hands and place your mouth on the mouth piece. Exhale around the mouth piece and make a tight seal on the mouthpiece. Inhale slowly to the count of 5 while you watch the disc move upward. Hold for a count of 5, loosen the seal around the mouthpiece & exhale. REPEAT 10 TIMES per hour while you are awake.

Activity

Walking and moving frequently are very important components of your recovery. The more you push yourself to exercise and move, the quicker and less painful your recovery will be. You may not feel up to moving, BUT YOU MUST.

This page was last updated on: March 3, 2008.