What are the other Names for the Procedure?
- En bloc Esophagectomy
- Ivor-Lewis Operation
- Minimally Invasive Esophagectomy (MIE)
What is Esophagectomy surgical procedure?
- Esophagectomy is the surgical removal of the esophagus
- An esophagus is a muscular tube and a part of the digestive system that connects the pharynx to the stomach
What part of the Body does the Procedure involve?
An Esophagectomy procedure involves the esophagus, stomach, and sometimes the colon or large intestine.
Why is the Esophagectomy surgical procedure Performed?
There could be various reasons for performing an Esophagectomy. Some of them are as follows:
- Cancer of the esophagus
- Scarring of the esophagus, due to ingestion of toxic chemicals
- Opening on the esophagus in newborns with a congenital defect
- Patients who have Barrett’s esophagus, which is a tissue-metamorphosis condition, associated with chronic gastroesophageal reflux disease (GERD). Due to this certain cancerous or pre-cancerous changes (termed as high-grade dysplasia) are noted on the esophagus
- Patients with achalasia, which is poor motility of food from the throat to the stomach
What are some Alternative Choices for the Procedure?
To treat any ailment related to the esophagus, an Esophagectomy procedure remains the gold standard technique.
What are the Recent Advances in the Procedure?
- The recent advances in the procedure are the use of laparoscopic technique (minimally invasive esophagectomy)
- Also, the manner (surgical approach) by which a surgeon accesses the esophagus during surgery, is currently an advancement in the procedure
What is the Cost of performing the Esophagectomy surgical procedure?
The cost of Esophagectomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://www.mayoclinic.org/esophagectomy/about.html (Accessed on 6th August, 2012)
http://www.nlm.nih.gov/medlineplus/ency/article/007397.htm(Accessed on 6th August, 2012)
http://www.uwmedicine.org/patient-care/our-services/medical-services/esophageal-gastric-diseases/pages/articleview.aspx?subid=66 (Accessed on 6th August, 2012)
Prior to Esophagectomy surgical procedure:
How is the Esophagectomy surgical procedure Performed?
- An incision is made on the chest and stomach, the skin, tissue, organs are placed aside to locate and isolate the esophagus
- The surgeon examines the esophagus carefully for any signs of abnormality
- In case of a tumor, the cancerous tissue and neighboring lymphatic glands are removed. The remaining portion of the esophagus is then joined with the stomach
- Lastly the organs and tissue are repositioned and closed with sutures
- Sometimes, when the esophagus cannot be joined with the stomach, a resection of a part of the colon is used to serve as an esophagus
Where is the Procedure Performed?
An Esophagectomy surgical procedure is performed in a hospital. The patient gets admitted, undergoes the procedure, and is discharged as per the instruction of the physician.
Who Performs the Procedure?
The procedure is performed either by a thoracic surgeon, a general surgeon, or a surgical oncologist along with an anesthesiologist and a pathologist.
How long will the Procedure take?
The procedure may take anywhere between 3-5 hours.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician evaluates the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
- Some of the medications may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
- Sometimes, blood test might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevents him/her from undergoing the procedure
- The patient must quit smoking and use of any nicotine based products
- They must control their blood sugar count within the normal blood sugar range; if not then their diabetologist may have to recommend insulin with a combination oral medication
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- A physician will request your consent for Esophagectomy procedure using an Informed Consent Form.
What is the Consent Process before the Procedure?
A physician will request your consent for the Esophagectomy procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Esophagectomy surgical procedure?
Before an Esophagectomy, the patient has to undergo certain tests such as:
- Routine blood and urine analysis
- X-ray of the upper gastro intestinal tract and chest
- Positron Emission Tomography (PET) imaging
- Endoscopic Ultrasound
- CT Scan
- Cardiac check-up
The physician may suggest further tests depending on the health of the patient and their medical history. Do note that the patient may have to do a few, or all of the above mentioned tests.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is an Esophagectomy?
- Why is this procedure necessary?
- What does the procedure involve?
- How will this procedure help?
- Will I be able to consume food normally post-surgery?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any lifestyle restrictions or modifications required, after the procedure is performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- Is there any medication that needs to be taken for life, after the procedure?
- What are the costs involved?
During the Esophagectomy surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia is administered during the procedure.
How much Blood will you lose, during the Procedure?
Since Esophagectomy is a complex surgical procedure, the blood loss may be significant. This may vary from person to person.
What are the possible Risks and Complications during the Esophagectomy surgical procedure?
The possible risks or complications that may arise during the surgery are:
- Excessive bleeding
- Accidental injury to the neighboring tissue or bone
- Blood or blood clot accumulation outside of the lungs (Hemothorax)
- Air in the chest cavity outside of the lungs (Pneumothorax)
- Blood clot formation in the legs (DVT - Deep vein thrombosis)
- Blood clot can travel to the lungs (PE - Pulmonary embolism)
- Heart attack
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Esophagectomy surgical procedure?
The healthcare facility must have an intensive care unit (ICU), where the patient may recover post-surgery. Apart from this no particular care is needed unless complications arise.
After the Esophagectomy surgical procedure:
What are the possible Risks and Complications after the Esophagectomy surgical procedure?
The possible risks and complications post-surgery are:
- Infection in the surgical wound
- Stroke or heart attack
- Problems in breathing
- Narrowing of the muscles of the tube connecting the esophagus and stomach
What is the Prognosis after the Surgery?
- If Esophagectomy is performed for cancer of the esophagus; the 5 year survival rate may vary, depending on the stage of the cancer
- If the procedure is performed for reasons other than cancer, then the prognosis is usually good
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain around the surgical wound
- Swelling and redness
- Bleeding or drainage
- Nausea or vomiting
- Signs of infection
- Shortness of breath
- If any new symptom or discomfort is observed
What Post-Operative Care is needed at Home after the Esophagectomy surgical procedure?
At home, the following post-operative care is recommended, after Esophagectomy procedure:
- Complete the course of medication
- Avoid oral consumption of food for the first few days, as advised by your surgeon
- Avoid tea, coffee, cold beverages, and alcohol
- Use heating pads to relieve incisional pain
- Elevate legs while resting
- Avoid strenuous exercises
- Avoid taking non-prescribed medications
- Avoid driving for 3-4 weeks
- Avoid sex till complete healing has taken place (under advise by the physician)
How long does it normally take to fully recover, from the Procedure?
It takes about 8-12 weeks to completely recover from the procedure.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Esophagectomy surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The hospital
- Thoracic surgeon, general surgeon, or a healthcare provider
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
The patient is advised to inquire and confirm the type of billing, before an Esophagectomy surgical procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA