Esophagectomy is the complete removal of the diseased portion of the esophagus and all associated tissues that might contain cancer. This surgery is not even considered in 60% of cases. Even when it is attempted, the procedure is frequently unsuccessful and has a high mortality rate immediately following surgery that accounts for 5% to 10%. This is due to the frequently weakened and malnourished status of the patient by the time the diagnosis is made, the difficulty of the surgery, and its proximity to many vital organs. Aggressive surgery, however, may be justified, particularly for some patients with lesions in the lower half of the esophagus.
Description of the Procedure
For this procedure, both the chest and the upper abdomen have to be exposed. The esophagus lies at the very back of the chest, behind the heart and breathing tubes, both of which have to be moved out of the way or worked around.
It may be that the surgeon, after exploring the cancer site, decides that the planned procedure cannot be successful and decides against it. If he or she chooses to go ahead, the first step is to identify all tissue that needs to be and can be removed. Since this includes the esophagus, a replacement must be found.
Most often the stomach is pulled up into the chest and attached to the upper end of the esophagus, above the cancer. In some cases, a synthetic tube or a piece of small intestine is substituted for the missing piece of esophagus.
Along with the diseased portion of the esophagus, the surgeon will remove every suspicious lymph node he or she can find. Few other organs in the area can be removed, even partially, thus limiting the usefulness of surgery for widely spread disease.
Your stay in the hospital may extend over several weeks due to the extensive nature of the surgery and the high rate of severe complications. Once you are home to recover, it may take even longer before you feel comfortable.