Esophagectomy: Purpose, Procedure, Benefits and Side Effects

Esophagectomy is a surgical treatment that removes all or part of the oesophagus, which is the tube that connects the mouth to the stomach and is responsible for transporting food.

• Ivor Lewis Esophagectomy: It is a type of esophagectomy in which the incision is made in the abdomen, followed by removal of the middle part of the oesophagus and reattachment of the stomach to the remaining part of the oesophagus.
• McKeown Esophagectomy: It is a type of esophagectomy that involves the removal of part or all of the oesophagus and reconstruction with a stomach tube.
• Transhiatal Esophagectomy: It is a type of esophagectomy that involves removing part or all of the oesophagus through an incision made in the abdomen but without splitting open the chest cavity.
• Thoracic Esophagectomy: It is a type of esophagectomy that requires an incision to be made in both chest and abdomen cavities to remove part or all of the oesophagus and reconstruct it with stomach tissue.

• Improved Quality of Life: Esophagectomy can help to improve quality of life by eliminating the symptoms and reducing the risk of complications associated with esophageal cancer.
• Reduced Risk of Cancer Recurrence: Esophagectomy is a very effective treatment for esophageal cancer, and it can reduce the risk of cancer recurrence.
• Reduced Risk of Metastasis: Esophagectomy has been shown to reduce the risk of metastasis, or spread, to other parts of the body.
• Improved Survival Rates: Esophagectomy has been shown to increase overall survival rates in patients with esophageal cancer and can lead to better long-term outcomes.

It is done to treat cancer of the oesophagus and other conditions such as achalasia, Barrett's oesophagus, and strictures.

In some cases, it may be used to remove tumours or foreign objects that have become lodged in the oesophagus.

• Pain: Pain can occur after an esophagectomy due to the surgical incision, as well as from stretching or irritation of the nerves that have been moved during surgery.
• Bleeding: Bleeding can occur during and after surgery, leading to excessive blood loss and a higher risk of infection.
• Infection: Esophagectomy is an invasive procedure, and there is a risk of infection in the area of the surgery or in the chest cavity.
• Difficulty swallowing: Swallowing may be difficult or painful after surgery, due to swelling or scarring in the area of the oesophagus that was removed.
• Leakage: There is a risk of leakage from where the stomach is connected to what remains of the oesophagus, leading to further complications such as infection or abscess formation.

• Talk to your doctor about the diagnosis and the several treatment options available.
• Talk to your physician about the surgery and the potential complications that might arise from it.
• If you smoke, you need to give up the habit before the treatment. Talk to your doctor about potential resources to help you quit smoking if necessary.
• Make sure you understand the pre-operative instructions provided by your doctor, including any medications to stop taking and any tests that must be completed before surgery.
• Talk with your doctor about ways to manage any pain that may occur after surgery.
• Arrange for transportation home from the hospital or other care facility after surgery and for help around the house during recovery if necessary.
• Follow a healthy diet high in fruits, vegetables, and lean proteins as recommended by your doctor prior to surgery, as poor nutrition can slow wound healing and recovery time following surgery

• The procedure is often carried out under general anaesthesia, and its duration might range anywhere from several hours to many days.
• Depending on where part of the body has the malignancy, the surgeon will either make an incision in the chest or the belly.
• In order to lessen the likelihood of the cancer spreading to other areas of the body, the surrounding tissue and lymph nodes could also be removed.
• In some cases, nearby organs such as the stomach, spleen, or lymph nodes may be affected, and they may need to be removed as well.
• After the surgery, a tube called a stent may be inserted into the new connection between the oesophagus and stomach to help it heal properly and keep it open for food to pass through.
• The patient may also receive chemotherapy or radiation therapy after surgery depending on their prognosis and treatment plan.
• After surgery, it will take time for recovery and for food to travel through the new connection between the oesophagus and stomach normally again, but most patients are able to resume eating regular food within several weeks or months after their surgery.

• Complete physical examination including laboratory tests to check for the presence of any underlying medical conditions.
• Imaging tests such as X-ray, CT scan or MRI to assess the size, shape and position of the tumour.
• Endoscopy to examine the oesophagus and take tissue samples for biopsy.
• Bronchoscopy to check the lungs for any spread of the tumour cells.
• Cardiac evaluation using electrocardiogram (ECG) or echocardiogram (ECHO).
• Blood tests for measuring haemoglobin levels and electrolytes levels, kidney and liver functions etc.
• Pulmonary function tests (PFT) to assess pulmonary reserve capacity and oxygen saturation levels in blood.

Anaesthesia: The patient is put to sleep using general anaesthesia.
• Abdominal incision: An incision is made in the abdomen to gain access to the oesophagus.
• Lymph node removal: The lymph nodes near the oesophagus will be removed and examined for possible cancer spread.
• Dissection of the oesophagus: The oesophagus is dissected away from other surrounding tissues and organs, such as the trachea, vagus nerve, and chest wall muscles.
• Division of the oesophagus: The oesophagus is divided into two parts and then separated from the stomach by cutting its attachments to other structures.
• Reconstruction of digestive tract: After removing the oesophagus, the surgeon will reconstruct a new digestive tract using a portion of your stomach or colon to form a connection between your mouth and stomach so that you can still swallow food and drink liquids normally.
• Closing incisions: When all of the procedures have been finished, any incisions that were made are stitched or stapled shut and then covered with a dressing or bandages.

• Post-operative Care: After the procedure of esophagectomy, post-operative care is essential for the patient’s recovery. This includes monitoring vital signs, providing pain relief, providing nutrition, and monitoring for potential complications that may arise from the surgery.
• Monitoring: The patient's vital signs should be periodically checked to make sure their bodies are operating normally.The patient should also be given pain relief regularly to reduce discomfort and help them heal.
• Nutrition: As the oesophagus has been removed, nutrition must be provided via a feeding tube until the patient’s stomach can take over the job of digesting food and absorbing nutrients again.
• Prevention of Complications: In order to prevent potential complications that may arise after an esophagectomy, patients are advised to avoid heavy lifting or strenuous activity for at least six weeks after surgery. In addition, they should make sure to stay hydrated and eat a nutritious diet to promote healing and reduce the risk of infection.
• Follow Up Visits: After an esophagectomy it is important for patients to attend follow up visits with their doctor in order to monitor their progress and make any necessary adjustments in their treatment plan if needed.

The cost of an esophagectomy in India varies depending on the type of procedure and the hospital, but typically ranges from around Rs. 75,000 to Rs. 2.5 lakhs .

Soft, mushy, and easily digestible foods: Soft foods such as mashed potatoes, yoghurt, applesauce, bananas, cooked cereal and oatmeal are easier to digest than hard foods. These are good options for a post-esophagectomy diet.

• Protein-rich foods: Protein is important for healing and repairing body tissues after surgery. Sources of protein such as fish, skinless poultry, tofu, eggs and low-fat cheese should be included in the diet.
• Healthy fruits and veggies: A great source of vitamins and minerals that aid in the healing process after surgery is fruits and vegetables.Foods like cooked carrots, squash, sweet potatoes or cooked spinach can be blended into purees for easier digestion.
• High fibre foods: Foods high in fibre such as bran cereal, whole grains like brown rice or quinoa can help to prevent constipation which is common after esophagectomy surgery.
• Fluids: After surgery, it's crucial to drink lots of fluids throughout the day, such as water, decaffeinated teas, or low-fat milk, to keep hydrated.

Esophagectomy is a significant surgical surgery with some risks and probable side effects.

It is generally considered safe when done by an experienced surgeon, but patients should discuss all potential risks and complications with their doctor prior to the procedure.

• Yes, esophagectomy can be painful. The actual operation is usually not difficult, but the healing process may be quite uncomfortable.
• Many patients experience chest pain and difficulty swallowing for several weeks after the procedure.
• Painkillers are often administered to aid with pain management.

An esophagectomy recovery period usually lasts 6 to 8 weeks, however it might be longer or shorter depending on the patient's general health and the scope of the operation.

At this period, it's crucial to adhere to your medical team's advice, which may include resting up and staying away from physically demanding activities.

Esophagectomy is a major surgical procedure that can cause a variety of side effects, including:

• Pain: The most frequent adverse effect of an esophagectomy is pain. Pain may sometimes be controlled by taking drugs.
• Nausea and vomiting: Nausea and vomiting are common after an esophagectomy and can be managed with anti-nausea medications.
• Difficulty swallowing: It may take weeks or even months for the body to adjust to the new anatomy after an esophagectomy. Swallowing food may become difficult as the body adjusts to the new anatomy, and this may require changes in diet or other treatments.
• Reflux: Reflux is common after an esophagectomy due to a weakened lower esophageal sphincter (LES). This can lead to frequent heartburn and difficulty eating certain foods, such as acidic foods and spicy foods.
• Infection: Infections are possible after any type of surgery, including an esophagectomy.To lower the chance of infection, it's crucial to adhere to your doctor's recommendations for taking antibiotics before and after your treatment.
• Bleeding: Bleeding is a possible complication of any surgery, including an esophagectomy. Your doctor will monitor you closely following the procedure for any signs of bleeding or other complications.

Esophagectomy is a surgical procedure to remove the oesophagus. Aftercare for esophagectomy involves:

• Monitoring vital signs: It is important to monitor the patient’s vital signs, such as heart rate, blood pressure, and temperature, closely after esophagectomy to detect any complications.
• Administration of antibiotics: Antibiotics are typically administered to prevent infections in the area of the surgery.Pain management: Painkillers may be provided to aid with post-operative discomfort and pain.
• Nutrition: Appropriate nutrition is essential for recovery after esophagectomy and may involve a liquid diet followed by a soft diet and then a regular diet as tolerated by the patient.
• Relearning how to swallow: Swallowing exercises and therapy may be necessary to relearn how to swallow correctly after an esophagectomy.
• Follow-up care: Regular follow-up care with the healthcare team is important during the recovery period from an esophagectomy to monitor progress and ensure that any potential complications are addressed promptly.

Esophagectomy is a surgical treatment that removes all or part of the oesophagus. It is done to treat cancer of the oesophagus and other conditions such as achalasia, Barrett's oesophagus, and strictures.