Esophagectomy or oesophagectomy is the surgical removal of all or parts of the

esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to t ...

Medical uses

The principal objective is to remove the esophagus, a part of the

gastrointestinal tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

. This procedure is usually done for patients with

esophageal cancer Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voi ...

. It is normally done when esophageal cancer is detected early, before it has spread to other parts of the body. Esophagectomy of early-stage cancer represents the best chance of a cure. Despite significant improvements in technique and postoperative care, the long-term survival for esophageal cancer is still poor. Multimodality treatment (

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...

and

radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Rad ...

) is needed for advanced tumors. Esophagectomy is also occasionally performed for benign disease such as esophageal atresia in children,

achalasia Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" usually refers to achalasia of the esoph ...

, or

caustic Caustic most commonly refers to: * Causticity, a property of various corrosive substances ** Sodium hydroxide, sometimes called ''caustic soda'' ** Potassium hydroxide, sometimes called ''caustic potash'' ** Calcium oxide, sometimes called ''caust ...

injury. In those who have had an esophagectomy for cancer, omentoplasty (a procedure in which part of the greater omentum is used to cover or fill a defect, augment arterial or portal venous circulation, absorb effusions, or increase lymphatic drainage) appears to improve outcomes.

Classification

Diagram showing before and after an oesophago-gastrectomy CRUK 107

There are two main types of esophagectomy. * A trans hiatal esophagectomy (THE) is performed on the

neck The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...

and

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the to ...

simultaneously. * A transthoracic esophagectomy (TTE) involves opening the

thorax The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the c ...

(chest). In most cases, the

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

is transplanted into the neck and the stomach takes the place originally occupied by the esophagus. In some cases, the removed esophagus is replaced by another hollow structure, such as the patient's colon. Another option that is slowly becoming available is minimally invasive surgery (MIS) which is performed laparoscopically and thoracoscopically. After surgery, patients may have trouble with a regular diet and may have to consume softer foods, avoid liquids at meals, and stay upright for 1–3 hours after eating.

Dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or liq ...

is common and patients are encouraged to chew foods very well or grind their food. Patients may complain of substernal pain that resolves by sipping fluids or regurgitating food. Reflux-type symptoms can be severe, including intolerance to acidic foods and large, fatty meals.

Jejunal The jejunum is the second part of the small intestine in humans and most higher vertebrates, including mammals, reptiles, and birds. Its lining is specialised for the absorption by enterocytes of small nutrient molecules which have been previous ...

feeding tubes may be placed during surgery to provide a temporary route of nutrition until oral eating resumes.

Process

Esophagectomy is a very complex operation that can take between 4 and 8 hours to perform. It is best done exclusively by doctors who specialise in

thoracic surgery Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs (lung disease), and other pleural or mediastinal stru ...

upper gastrointestinal surgery Digestive system surgery, or gastrointestinal surgery, can be divided into upper GI surgery and lower GI surgery. Subtypes Upper gastrointestinal Upper gastrointestinal surgery, often referred to as upper GI surgery, refers to a practise of surg ...

Anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

for an esophagectomy is also complex, owing to the problems with managing the patient's

airway The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose t ...

and

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...

function during the operation. Lung collapse is highly probable, as well as loss of diaphragmatic function, and possible injury to the spleen. Average mortality rates (deaths either in hospital or within 30 days of surgery) for the operation are around 10% in US hospitals. Recognized major cancer hospitals typically report mortality rates under 5%. Major complications occur in 10–20% of patients, and some sort of complication (major and minor) occurs in 40%. Time in hospital is usually 1–2 weeks and recovery time 3–6 months. It is possible for the recovery time to take up to a year. File:Diagram showing before and after a partial oesophagectomy CRUK 103.svg, Diagram showing before and after a partial oesophagectomy File:Diagram showing before and after a total oesophagectomy CRUK 105.svg, Diagram showing before and after a total oesophagectomy File:Diagram showing a total oesophagectomy using bowel to replace the oesophagus CRUK 080.svg, An esophagectomy using the bowel (colon) to replace the esophagus

References

{{Digestive system surgical procedures Surgical oncology Surgical removal procedures Digestive system surgery

Medical uses

Classification

Process

See also

References