What is an esophagectomy?
An esophagectomy is a surgery to remove part or all of the esophagus (the tube through which food travels from the throat to the stomach). It is most often performed for esophageal cancer, a condition in which malignant (cancerous) tumors develop in the esophagus. It may also be performed for benign (nonmalignant) diseases of the esophagus where the esophageal function has deteriorated to the point that the individual can no longer swallow.
What are the different kinds of esophagectomy?
There are several different approaches (surgical methods) for an esophagectomy, depending on the number of incisions (cuts) and where the incisions are made. This is determined by several factors, including where the tumor is located, if the patient has had an earlier surgery, and the preference of the surgeon.
The surgical approaches include the following:
- McKeown esophagectomy: The incisions are made in the neck, chest and abdomen (belly) to remove the esophagus and rebuild the gastrointestinal tract.
- Thoracoabdominal esophagectomy: A single incision is made from the chest to the abdomen on the left side, and an incision is made in the neck.
- Transhiatal esophagectomy: Incisions are made in the neck and abdomen, with the intervening esophagus being dissected out bluntly (with the fingers).
- Ivor Lewis esophagectomy: One incision is on the right side of the chest and the other in the abdomen.
- Minimally invasive esophagectomy: The surgeon may choose to do a portion or all of the esophagectomy using minimally invasive techniques. A robot may be used in the chest and/or abdomen, a thoracoscope may be used in the chest, or a laparoscope may be used in the abdomen. (Thoracoscope and laparoscope are long, thin, flexible instruments for examining the chest and abdomen.) When minimally invasive components are mixed with more traditional “open” components, the procedure is described as a “hybrid” procedure.
Regardless of the type of esophagectomy, a jejunostomy tube (feeding tube) is placed as part of the esophagectomy. This is used to provide nutrition for up to 30 days after the surgery as the patient recovers his or her swallowing function.
The patient will also have a nasogastric tube, a drain that goes in through the nose. This tube is essential for keeping the stomach decompressed in order to give the new connection from the esophagus to the stomach a better chance to heal.