ESOPHAGECTOMY

General Information

DEFINITION--Removal of part of the esophagus, the tubular passage from the back of the throat to the stomach.

BODY PARTS INVOLVED--Esophagus; stomach; small intestine (sometimes).

REASONS FOR SURGERY

• Cancer of the esophagus.
• Burns and scarring of the esophagus.
• Opening a closure of the esophagus in a newborn (usually an inherited defect).

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity; smoking; poor nutrition.
• Excess alcohol consumption.
• Newborns and infants.
• Chronic or recent illness, especially pneumonia.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; narcotics; beta-adrenergic blockers; or cortisone.

What To Expect

WHO OPERATES--General surgeon or thoracic surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; x-rays of chest and upper gastrointestinal tract.
• After surgery: Blood and urine studies; x-rays of chest and upper gastrointestinal tract.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• Incisions are made in the abdomen and chest to expose the esophagus.
• The esophagus is isolated and examined.
• Abnormal tissues are removed. If the surgery is performed to treat cancer, nearby lymph glands are also removed.
• The bottom end of the remaining part of the esophagus is joined with the stomach or small intestine.
• The chest and abdomen are closed in layers. The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Incisional hernia.
• Leakage of digestive material from new junction of esophagus and intestinal tract.
• Scarring at operation site to prevent normal passage of food and fluids.

AVERAGE HOSPITAL STAY--18 days.

PROBABLE OUTCOME--If the surgery was performed to treat cancer in its early stages, chances of 5-year survival are good. If the surgery was performed for other reasons, expect complete healing without complications. Allow about 8 to 12 weeks for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--vein blood clots.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Antibiotics to fight infection. > Stool softeners to prevent constipation.

ACTIVITY

• Resume daily activities and work as soon as possible.
• Avoid vigorous exercise for 12 weeks after surgery.
• Resume driving 3 weeks after returning home.
• Resume sexual relations when able.

DIET--Nothing by mouth for the first 3-4 days to allow healing of the connection between the esophagus and the stomach.. Then eat a well--balanced diet to promote healing. Avoid coffee, tea, cocoa, cola drinks, alcoholic beverages and any food or spice that cause indigestion.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You experience vomiting, excessive weakness or black, tarry stools.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.