Esophageal Cancer

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Surgery

Dr. Farhood Farjah Describes an Esophagectomy Procedure

Surgery to remove part or all of the esophagus (esophagectomy) is key to effectively treating esophageal cancer. During this procedure, your surgeon will remove the cancerous part of your esophagus, lymph nodes in the area, and other nearby tissue. The surgeon connects any remaining healthy part of your esophagus to your stomach so you can swallow normally. Your stomach or part of your intestine may be used to make the connection.

Typically doctors recommend surgery for early stage cancers (stage I) and for many locally advanced cancers (stage II and III).

Choose an Experienced Surgery Center

Seattle Cancer Care Alliance (SCCA) patients receive esophageal cancer surgery from top surgeons at the Thoracic Surgery Clinic and Center for Esophageal & Gastric Surgery at UW Medical Center. These specialists perform a high volume of esophagectomies every year and often are on the leading edge of developing the newest, latest techniques and teaching these techniques to other doctors.

UW Medicine is one of only a few sites in the United States that specialize in diagnosing and surgically treating esophageal and gastric diseases. When you have esophageal cancer, it is very important to choose a surgeon and hospital experienced in performing esophagectomies. Studies show that the volume of these surgeries performed by a hospital is a strong predictor of patient outcomes.

Esophagectomy Techniques

There are many ways to perform an esophagectomy. The method your surgeon uses will depend on the location of your tumor.

Transhiatal Esophagectomy

In this method, the surgeon makes incisions in the neck and abdomen. Most of the esophagus is removed through these incisions. Because there’s no incision in the chest wall and the lungs do not have to be deflated for the surgeon to reach the esophagus, this method may result in fewer complications, such as pneumonia. Typically the surgeon attaches the stomach to the remaining esophagus in the neck. Sometimes, a segment of the colon is used to connect the esophagus to the stomach.
 

Ivor-Lewis Esophagectomy
In this method, the surgeon makes one incision in the abdomen and one in the chest along the ribs. The lower half of the esophagus is removed through the abdominal incision, and the stomach is attached to the upper esophagus in the chest.




Total Esophagectomy
This surgery is used to remove the entire esophagus when there are large tumors in the middle of the esophagus. The surgeon makes incisions in three places: the abdomen, chest, and neck. The esophagus is separated from other chest structures and organs through these incisions, and then it’s removed. The surgeon will create a new passage for food from the throat to the stomach, typically with a segment of the small intestine or colon.

 

Minimally Invasive Surgery
For many patients, surgeons can use a minimally invasive approach to remove the part of the esophagus affected by cancer.

 

The surgery is performed through five small incisions that are one-quarter to one-half inch long. The surgeon inserts a fiber-optic camera through the incisions in order to see the esophagus and other structures without having to make any large incisions in the neck, chest, or abdomen. Through the other small incisions, the surgeon operates using small surgical instruments.

When the incisions are made in the chest, this type of surgery is called a thoracoscopy. When the incisions are in the abdomen, the surgery is called a laparoscopy. The benefits to both are less pain, faster recovery, and fewer problems with incisions.

Most SCCA patients who need surgery for esophageal cancer can have minimally invasive surgery. Our surgeons are among the country’s leading experts in minimally invasive surgery. You and your doctor will discuss whether this approach is right for you.

Surgery Risks

All surgeries carry some risks. A major complication that can occur with esophageal surgery is that the esophagus leaks where it was cut and reattached. Other complications can include atrial fibrillation, pneumonia, lung collapse, bowel obstruction, and vocal-cord paralysis or long-term hoarseness.  To reduce your risk of major complications from esophageal surgery, it is important to go to a hospital where the surgeons have extensive experience performing these procedures.

After Surgery

After surgery is performed, it is typical to spend a week or more in the hospital to recover. In some cases, recovery can take up to six months. Your SCCA team members will work with you to ensure you receive the care and support you need during your recovery time.

After esophageal surgery, dietary habits often have to change. Eating smaller portions of soft foods, avoiding high-fat and spicy dishes, and not drinking liquids with meals are all common changes patients make after esophageal cancer surgery. Many people find it easier to puree meals. You may also find it helpful to eat more slowly and to stand or sit upright for a few hours after meals to reduce reflux and regurgitation. We provide nutrition support to help you make these adjustments while getting the nutrition you need.