Surgery for Esophageal Cancer: Objectives, Varieties, and Healing Process
In the fight against esophageal cancer, one of the most common surgical procedures is an esophagectomy. This article aims to provide a clear and concise overview of the various types of esophagectomy, their surgical techniques, and the recovery process.
An esophagectomy involves the removal of part or all of the esophagus, often accompanied by a procedure known as a lymphadenectomy, where nearby lymph nodes are removed to prevent the spread of cancer. However, this procedure carries risks such as lymphedema, postoperative infection, blood clots, nerve damage, and complications during the healing process.
The survival rate after esophagectomy is influenced by several factors, including the surgeon's experience and the hospital's survival statistics. The most common type of esophageal cancer surgery is an esophagectomy, and eligibility for the procedure depends on factors such as overall health, location of the tumor, and its extent of spread.
There are several common types of esophagectomy, each with its unique surgical technique.
- McKeown Esophagectomy (Three-Hole Esophagectomy) This procedure involves three incisions: one in the neck, one in the chest, and one in the abdomen. The esophagus is mobilized through these incisions, and an anastomosis (connection) between the stomach and the remaining healthy portion of the esophagus is performed in the neck (cervical anastomosis). This method allows extensive lymph node dissection in the neck, chest, and abdomen, often used for tumors higher in the esophagus.
- Ivor Lewis Esophagectomy (Two-Hole Esophagectomy) Typically, this procedure involves incisions in the abdomen and right chest only. The esophagus is mobilized, and the anastomosis is performed in the chest (intrathoracic anastomosis). This method is commonly used for tumors located in the middle or lower esophagus, where the tumor site does not require cervical lymph node dissection.
- Transhiatal Esophagectomy This procedure involves incisions in the neck and abdomen, without opening the chest. The surgeon mobilizes the esophagus through the hiatus in the diaphragm and performs the anastomosis in the neck. This less invasive option avoids thoracotomy and reduces pulmonary complications, although it offers less extensive lymph node dissection compared to McKeown’s approach.
- Thoracoabdominal Esophagectomy This procedure involves a large incision that crosses the chest and abdomen, allowing wide exposure for tumor resection and lymph node dissection. However, due to its higher morbidity compared to minimally invasive methods, it is less commonly used now.
Each technique balances the location and extent of the tumor, lymph node dissection requirements, and patient recovery considerations. Minimally invasive approaches, such as laparoscopic, thoracoscopic, and robotic methods, are increasingly preferred to reduce postoperative pain and complications.
After an esophagectomy, a surgeon reattaches the stomach to the remaining healthy portion of the esophagus, which may result in rapid gastric emptying (dumping syndrome) and symptoms like nausea, diarrhea, lightheadedness, or tiredness. A dietitian can help manage the symptoms of dumping syndrome with a tailored meal plan.
People who undergo esophagectomy with or without additional treatments have a 5-year relative survival rate of 30-45%, depending on the stage of the cancer. For the first 8 weeks following an esophagectomy, heavy lifting and strenuous activities should be avoided.
According to the NHS, about 50% of people who receive esophagectomy develop a complication that increases the length of their hospital stay. People typically remain in the hospital for 1-2 weeks after esophagectomy and return to normal activities around 3 weeks after surgery. The lab checks the removed lymph nodes for cancer cells, and if cancer cells are present, additional treatments like chemotherapy or radiation therapy may be recommended.
In minimally invasive esophagectomy, the procedure is performed through a series of small incisions with the aid of a laparoscope.
Removal of the esophagus and nearby lymph nodes can cure early stage esophageal cancer, but doctors often do not diagnose esophageal cancers early enough to be cured with surgery alone.
- The removal of part or all of the esophagus, often accompanied by a procedure to remove nearby lymph nodes, is a common surgical procedure called esophagectomy that is commonly used in the fight against esophageal cancer.
- Each type of esophagectomy has its unique surgical technique, such as the McKeown Esophagectomy (Three-Hole Esophagectomy) that involves three incisions: one in the neck, one in the chest, and one in the abdomen.
- In oncology, understanding medical-conditions like esophageal cancer and the surgical procedures used to treat them, like esophagectomy, is essential for the science of health-and-wellness.
- The various types of esophagectomy used to treat esophageal cancer, when accompanied by additional treatments like chemotherapy or radiation therapy, may increase a patient's 5-year relative survival rate from 30-45%.
