Esophagectomy

What is Esophagectomy

Esophagectomy is a surgical procedure to remove some or all of the swallowing tube that connects the back of your throat to your stomach (esophagus).

There are different ways to do esophagectomy. The method that is used will depend on what part of your esophagus needs to be removed and on your surgeon.

• If the lower part of the esophagus will be removed, you may only have incisions in your belly, but you may also have an incision on your chest.
• If the upper part or all of the esophagus will be removed, you may have incisions in your belly, neck, and chest.

You may have this procedure to treat cancer of the esophagus. It also may be done to treat some conditions that prevent the esophagus from working properly.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any medical conditions you have.
• Any surgeries you have had.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Infection.
• Frequent nausea and vomiting.
• Frequent heartburn.
• Voice changes or loss.
• Narrowing (stricture) of the esophagus. This blocks or limits swallowing.
• Leaking of food or stomach fluids in the neck, chest, or abdomen.
• Damage to other structures or organs.
• Blood clots in the legs or lungs.
• Pneumonia.
• Allergic reactions to medicines or dyes.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.
• Plan to have someone take you home from the hospital or clinic.
• You may have nutrition counseling to prepare you to manage your diet at home after surgery.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A tube will be placed into your bladder to drain urine (catheter).
• A tube will be placed through your nose and into your stomach to drain stomach fluids (nasogastric tube, or NG tube).
• Another IV tube may be placed into a vein in your neck (central venous line).
• The surgeon will make an incision in your abdomen to find where your lower esophagus attaches to your stomach. Your esophagus will be separated from your stomach.
• Your surgeon will make another incision in your chest or neck to locate the upper part of your esophagus. The affected part will be removed.
• The top of your stomach will be brought up to meet the new end of the esophagus. The stomach may be changed into the shape of a tube. The upper end of the stomach will then be attached to the end of the esophagus with stitches (sutures) or staples.
• If you are having surgery for cancer, lymph nodes may be removed.
• You may have a tube placed into the upper part of your small intestine and brought out through the skin of your belly. This tube will be used to feed you while you recover from surgery (feeding tube).
• You will also have tubes put in to drain fluid that builds up after surgery. These drains will be placed near your incisions.
• Your incisions will be closed with sutures or staples.
• Dressings (bandages) will be placed over the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You will get pain medicine and fluids through an IV tube, and you may get nutrition through the feeding tube.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will be asked to take deep breaths and cough regularly to clear your lungs. This helps prevent pneumonia.
• You may be given medicine to prevent blood clots.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will have an X-ray to check for any leaks where your stomach was attached to your esophagus. If there are no leaks, your nasogastric tube can be removed.
• Your surgeon will decide when the rest of your tubes, drains, and IV tubes can be removed. You may go home with a feeding tube.
• You will be encouraged to walk.
• If you go home with a feeding tube, your health care provider will give you instructions for home care. At first, you may have a home care nurse to help you manage tube feeding and nutrition at home.

Summary

• Esophagectomy is a surgical procedure to remove a damaged or diseased part of your esophagus.
• Depending on the part of the esophagus that is removed, you may have incisions in your belly, chest, or neck.
• You will get pain medicine and fluids through an IV tube, and you may get nutrition through the feeding tube.

Esophagectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Soreness near the incision sites.
• Soreness when swallowing food.
• Tiredness (fatigue).
• Loss of appetite.
• Nausea.
• Heartburn.
• Diarrhea.

Follow these instructions at home:

Feeding tube

• If you were sent home with a feeding tube, follow instructions from your health care provider about taking care of the tube.
• Work with your nutrition care provider for using your feeding tube and getting enough nutrition.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions. You may need to eat smaller and more frequent meals.
• Drink enough fluid to keep your urine clear or pale yellow.

Activity

• Do notlift anything that is heavier than 10 lb (4.5 kg) until your surgeon says you can.
• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Change your bandage (dressing) as told by your health care provider.
  • Wash your hands with soap and water before you change your dressing. If soap and water are not available, use hand sanitizer.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
• Do nottake baths, swim, or use a hot tub until your health care provider approves

Check your incision areas every day for signs of infection. Check for:

• More redness, swelling, or pain.
• More fluid or blood.
• Warmth.
• Pus or a bad smell.

General instructions

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Wear compression stockings as told by your health care provider. These stockings help prevent blood clots and reduce swelling in your legs.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have problems or questions about your feeding tube.
• You have chills or fever.
• You have pain that is not controlled by your pain medicine.
• You have trouble swallowing.
• You have persistent or worsening heartburn.
• You have persistent or worsening diarrhea.
• You have more redness, swelling, or pain around your incision area.
• You have more fluid coming from your incision area.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision area.
• You have a persistent or worsening cough.

Get help right away if:

• You have severe pain.
• You are bleeding from an incision area.
• You are vomiting blood.
• You are unable to swallow.
• You have trouble breathing.
• You have chest pain.

Summary

• Expect some discomfort and fatigue during your recovery.
• Work with your nutrition care provider if you still have a feeding tube at home.
• Follow your surgeon’s directions for care of your incision areas.
• Return to normal activities gradually, as told by your health care provider.