Esophagectomy

What is an esophagectomy?

An esophagectomy is surgery to remove all or part of your esophagus. This is the tube that carries food and liquid from your throat to your stomach. You may need this surgery if you have esophageal cancer or your esophagus isn’t working as it should to help you swallow.

During the procedure, your surgeon will remove the damaged part of your esophagus and some of your lymph nodes (if you have cancer) for testing. Then, they’ll stitch together the remaining tissue to reconstruct your digestive system so you can eat.

Types of esophagectomy

All esophagectomies remove your esophagus. But, your surgeon’s specific technique depends on many factors, including where the tumor (or damage) is located and the specific procedure that benefits you most.

Open versus minimally invasive esophagectomy

Your surgeon may perform traditional open surgery, which involves making a single incision (cut) into your skin or tissue to access your esophagus.

They may perform all or part of your surgery using a minimally invasive technique called laparoscopic surgery to access organs in your abdomen. Laparoscopy involves accessing your esophagus and operating through a few 1-inch incisions. Your surgeon might also use thoracoscopic surgery, a similar minimally invasive procedure to access organs in your chest.

Esophagectomy techniques

Common techniques include:

• Transhiatal esophagectomy: A surgeon makes incisions in your neck and abdomen.
• Ivor Lewis esophagectomy: A surgeon makes one incision on the right side of your chest and the other in your abdomen.
• McKeown esophagectomy: A surgeon makes incisions in your neck, chest and abdomen.
• Thoracoabdominal esophagectomy: A surgeon makes a single incision from your chest to your abdomen on the left side and another incision in your neck.

Ask your surgeon to explain their approach and why it’s the best option for you. They’ll help you understand how the procedure will impact your experience and recovery time.

Why would someone need an esophagectomy?

An esophagectomy is the most common surgery to treat esophageal cancer. It also treats conditions that increase your risk of cancer, like Barrett’s esophagus, and benign (noncancerous) conditions that prevent your esophagus from working as it should.

How should I prepare for an esophagectomy?

An esophagectomy is a major surgery with a long recovery time. Before having this procedure, you may need many tests to ensure you’re a strong candidate for surgery. You may need to change some parts of your daily routine to increase the likelihood of a successful surgery.

You may need to:

• Get imaging tests: You may need imaging procedures, including a computed tomography (CT) scan of your chest and abdomen, an endoscopic ultrasound (EUS) or a PET scan (positron emission tomography scan). These procedures allow your provider to locate the tissue that needs to be removed so they can plan for surgery.
• Getting preliminary treatments: If you have esophageal cancer, you may need cancer treatments like chemotherapy and radiation therapy before surgery. Studies show that getting these treatments beforehand leads to better long-term results for some people.
• Ensure you’re healthy enough for surgery: Managing conditions like diabetes and high blood pressure before surgery can reduce the risk of complications afterward. Your provider will also help you quit tobacco and nicotine products if you use them. Smoking slows the healing process.
• Take steps to prepare for recovery: You may work with a dietitian to prepare for changes in your eating and drinking after having your esophagus removed. You may work with a speech-language pathologist (SLP) to learn exercises that strengthen your breathing muscles to prevent respiratory (lung) complications after surgery.
• Plan your hospital stay: Plan to spend a week or two in the hospital. Pack must-have items, including practical ones (like your medications). Bring comfort items, like your favorite pillow and a good book.
• Plan for home recovery: You’ll need someone to drive you home from the hospital and help you while you recover. Rearrange things around your home so you can access essential items without straining to reach or carry them.

In the days leading up to your procedure, follow your provider’s guidance on:

• Which medicines to take: For example, you may need to avoid using blood thinners (including aspirin) before surgery.
• When to start fasting: You may need to limit what you eat and drink before surgery. For example, you may need to switch from hard foods to a liquid diet before an esophagectomy.

What happens during an esophagectomy?

Before surgery, you’ll get anesthesia to put you to sleep so you don’t feel any pain. Your surgeon may place an epidural catheter into your back to help with pain management after surgery.

1. Depending on the procedure, your surgeon will make one or more cuts into your neck, chest or abdomen so they can access your esophagus.
2. Your surgeon will remove the diseased or damaged part of your esophagus. Often, they’ll remove a smaller portion of your stomach. In severe cases, they may need to remove all of your stomach.
3. The surgeon will pull your stomach (or small intestine) up into your chest or neck area (depending on the surgery type) and reconnect it to the remaining esophagus.
4. If you have esophageal cancer, your surgeon will also remove lymph nodes to check them for cancer cells in a lab. Lymph nodes are glands that filter fluid or lymph. Having cancer cells in your lymph nodes means the cancer has spread outside your esophagus.

Regardless of the type of esophagectomy, you’ll need a feeding tube to provide nutrition as you recover your ability to swallow. Your surgeon will insert the tube into your stomach or small intestine.

You’ll also have a nasogastric tube, a drain that goes in through your nose. This tube suctions out excess air in your stomach, which helps you heal. You may need chest drains to empty fluid that collects in your chest cavity, as well. This also helps you heal.

How long does an esophagectomy take?

An esophagectomy is a complex surgery. Most surgeries take around three to six hours.

What happens after an esophagectomy?

After an esophagectomy, your care team will move you to the intensive care unit (ICU) for a day or two. You’ll start receiving nutrition through the feeding tube, and your care team will adjust the epidural to manage pain. You may be in the hospital for up to two weeks after surgery.

While in the hospital, you’ll transition to taking liquid pain medications through the feeding tube. Your care team will remove your nasogastric tube and drains once you don’t need them. To help you heal:

• You’ll wear compression stockings and start walking around to prevent blood clots.
• You’ll perform breathing exercises, like taking deep breaths and coughing, to clear your lungs.
• You’ll learn to care for your feeding tube and clean your incision.

In this care phase, you’ll see many healthcare providers, including your surgical team, respiratory therapists, physical therapists and social workers. They’ll help prepare you to go home.

What are the side effects and risks of an esophagectomy?

It’s common to experience side effects after surgery. Your care team will monitor your health and help manage your symptoms. Side effects include:

• Fatigue.
• Loss of appetite.
• Pain when you swallow.
• Indigestion symptoms (heartburn, bloating and gas).
• Nausea & vomiting.
• Diarrhea.

These symptoms typically improve as you heal, but some (like indigestion problems) may remain.

The main risks of an esophagectomy include:

• Respiratory problems, including pneumonia (most common).
• Leaking at the area where your stomach and esophagus connect (anastomotic leak).
• Irregular heartbeat that can slow blood flow (atrial fibrillation).
• Trouble speaking or swallowing (dysphagia).
• Nausea & vomiting.
• Bleeding at the surgery site.
• Acid reflux.
• Blood clots.
• Infection.

Alert your provider if you notice any signs of a complication.

What should I expect after an esophagectomy?

Life after an esophagectomy takes lots of adjustment. Depending on your condition and the type of surgery you had, you may need visits from a care nurse to guide you through the recovery process at home.

Eating and drinking

You’ll likely continue eating and drinking through a feeding tube for up to two months. Eventually, you’ll transition to a liquid diet and then soft foods. Once you’ve healed and your care team says it’s safe, you can transition to a meal plan with most of the foods you ate before surgery.

You may need to change how often you eat and your portions. You’ll need to account for a shorter digestive system that’ll need more time to digest what you eat. For example, you may need to eat several small meals a day instead of three big ones. You may need to cut your food up into small pieces and chew slowly. Taking care can prevent indigestion symptoms, like heartburn.

Be patient with yourself as your body adjusts to these changes.

Hygiene and wound care

You may need to stick to only taking sponge baths first. Your healthcare provider will let you know when it’s safe to transition to showers or baths.

Part of cleaning yourself will involve cleaning around your feeding tube and flushing it. Your care team at the hospital or a home health nurse will teach you how to do this.

You’ll also need to learn how to clean and dress your wound and check for signs of infection. Contact your provider if you notice:

• Bleeding or drainage around the incisions.
• A wound that’s red or warm to the touch.

Exercise

You likely won’t feel like exercising during recovery, but it’s important to get moving to prevent blood clots. At first, your healthcare provider may recommend taking brief walks every few hours just to stay in motion.

It’s essential to follow your provider’s instructions about which activities are safe and which aren’t. For example, even lifting something light (10 lbs.) can be too much when you’re recovering. Movement is good for recovery, but overexertion isn’t.

What is the recovery time after an esophagectomy?

It may take a year or two to feel like you’ve healed and adjusted to life post-surgery. Still, everyone’s situation is different. Your condition before surgery greatly impacts your recovery time.

Instead of thinking of recovery as one time period, it can be helpful to think in terms of milestones, including the day when you’re eating the foods you enjoy and the day when you don’t have exercise restrictions. Every milestone matters.

When should I call my healthcare provider after an esophagectomy?

Call your provider if you have any questions about caring for yourself, your incisions or your feeding tube. Contact your care team if you:

• Have worsening pain or fevers.
• Notice warmth or redness around the incisions.
• Are feeling weak.
• Become short of breath.
• Feel your heart racing.
• Have diarrhea or black stools.
• Feel burning in your throat.
• Have a cough that doesn’t go away.
• Develop jaundice (yellowing of the whites of the eyes or the skin).
• Have trouble swallowing.
• Can’t stop losing weight.

Go to the emergency room (ER) or call 911 immediately if you:

• Can’t swallow or breathe.
• Are vomiting blood.
• Have severe pain, including chest pain.