Thoracic Oncology Program

Patient and Family Education

Esophageal Cancer

Esophagectomy

Surgical Resection

Surgical resection (removal) of the esophagus is indicated in several types of esophageal abnormalities, as well as for esophageal cancer. Your surgeon will choose one of several approaches for the removal of your esophagus and will describe the specific approach to be used for you.

Surgical Approach

After you have received your epidural for pain control and are asleep, the surgeon will remove the mass and form a replacement esophagus out of your stomach. The surgery will take approximately 6 hours. Additional time may be needed before surgery to insert intravenous lines and put you to sleep. The esophagus and associated lymph nodes will be sent to pathology for analysis. The final pathology report usually takes 10 to 14 days. The surgeon will notify you of your diagnosis as soon as he has the final report. If you have not heard from him within two weeks, please contact the office.

ESOPHAGECTOMY

Left Transthoracic (Chest) Approach

Ivor-Lewis (Belly and Right Chest)

Three Hole Esophagectomy Right Chest/Belly/Left Neck)

Transhiatal (No Chest Incision)

Surgical Approaches

There are four currently used surgical approaches for an esophagectomy--Transthoracic, Ivor-Lewis, 3-Hole Esophagectomy and Transhiatal. Approaches are chosen by the surgeon in order for the esophagus, tumor or obstruction, and lymph nodes to be adequately removed. Sometimes a neck incision will need to be made instead of an abdomen incision due to the location of the tumor.

Risks & Potential Complications

Your surgeon will explain the risks and alternatives to surgery in detail with you. It is an extensive procedure, requiring a significant about of time under general anesthesia. Every possible precaution will be taken. The major risks of an esophagectomy are leaks from the internal suture line, pneumonia or infection, bleeding, abnormal heart rhythms, and rarely heart attack and death.

Feeding Tube

If you have not previously had a feeding tube placed, you will have one inserted into your small intestine during the operation. This will be used to feed you during the time you are not able to eat by mouth. It will help keep your body in optimal condition during the postoperative period and will be removed approximately 1 month after surgery.

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, IV medications and epidural catheters. 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.

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.
Epidural Catheter: This is a very small tube placed in your back at the time of surgery. Pain medication is infused through the catheter, which will bathe the spinal cord and prevent pain. You may have a PCA button for your epidural pain medicine (see above).
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 makes you too sleepy.

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 your 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. You will be up in the chair the night of surgery and walking in your room the next morning.

Nutrition

You will not be allowed to eat or drink ANYTHING for the first week after surgery. You will have a nasogastric tube (NG tube) inserted into your nose through your new "esophagus", past the internal incisions while you are in surgery. NO ONE except your attending surgeon should remove or reposition this tube. This tube will be attached to suction & will drain the fluid secreted by your stomach. Your nurse will flush this tube several times each day to keep it clear. As long as it is working properly, you should not feel nauseous or vomit. Tell your nurse if you do feel nauseous.

You will receive IV fluids for the first week. Any extra medicines you need will also be given through your IV.
You will begin feedings through the feeding tube in your abdomen on the first or second day after surgery. The amount of these feedings will be increased slowly over the next several days.
You will have a swallowing test within 7-14 days of your surgery. You will be given a special liquid to drink while x-rays are taken. If there are no areas of leaking fluid on the xrays , your doctor will remove your NG tube and you will be allowed to take sips of clear liquids. Your diet will be increased gradually to 6 small SOFT meals each day.

This page was last updated on: September 16, 2009.