Esophagus Cancer Overview

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Treating Esophagus Cancer TOPICS

Surgery for cancer of the esophagus

How much surgery is done depends on the stage of the cancer. Surgery can also be used along with other treatments such as chemotherapy (chemo) and radiation treatment.

While surgery can cure some patients whose cancer has not spread beyond the esophagus, often these cancers are not found early enough. So it’s important to know whether the goal of surgery is it to try to cure the cancer or to ease symptoms.

Esophagectomy

Surgery to remove all or part of the esophagus is called an esophagectomy. Often a small amount of the stomach is taken out, too. When the esophagus is removed as treatment for cancer, lymph nodes near the esophagus are also removed. The top of the esophagus is then reattached to the stomach, or the surgeon may replace the removed part of the esophagus with a piece of the small or large intestine.

There are several different ways to do an esophagectomy. All of these surgeries are complex. Surgeons who do this surgery must be experts. You should feel free to ask your surgeon about his or her experience with these operations and how many were successful. The success rate is higher when surgery is done in a hospital where it is done often.

There are 2 main ways to do an esophagectomy:

Open esophagectomy

Many different approaches can be used for surgery on esophageal cancer. The main cut (incision) is often in either the chest or the belly (abdomen). Some methods involve incisions in the neck, chest, and abdomen. You and your surgeon should discuss in detail the planned operation and what you can expect. The surgeon may use pictures to show you how the operation will be done.

Minimally invasive esophagectomy

For some early (small) cancers, the esophagus can be removed through several small incisions (cuts). The surgeon puts a scope (like a tiny telescope) through one of the incisions to see everything during the operation. Then long, thin surgical instruments go in through other small incisions. In order to do this type of surgery well, the surgeon needs to be highly skilled and have a great deal of experience removing the esophagus this way. When successful, this surgery allows the patient to leave the hospital sooner and recover faster.

No matter which approach is used, esophagectomy is not a simple operation, and it may require a long hospital stay.

If the cancer has not yet spread beyond the esophagus, taking out the esophagus might cure the cancer. But most esophageal cancers are not found early enough for doctors to cure them with surgery.

Taking out lymph nodes

When taking out some or all of the esophagus, nearby lymph nodes are removed too. These are then checked to see if they contain cancer cells. If the cancer has spread to lymph nodes, the outlook is not as good, and the doctor may recommend other treatments after surgery.

Risks and side effects of surgery

Like most major operations, surgery of the esophagus has some risks. A heart attack or a blood clot in the lungs or the brain can happen during or after surgery. Lung problems are common. Infection is a risk with any surgery. The patient may get pneumonia, leading to a longer hospital stay, and sometimes even death. There may be a leak at the place where the stomach is attached to the esophagus, which could mean another surgery. After surgery, the stomach may empty too slowly. Sometimes this can lead to frequent nausea and vomiting.

Some patients have narrowing of the esophagus which causes trouble swallowing after surgery. To relieve this symptom, these narrow places can be stretched during an upper endoscopy. After surgery, bile and stomach contents can get into the esophagus because the muscle that normally controls this (the lower esophageal sphincter) is often removed or changed by the surgery. This can cause heartburn and other symptoms. Sometimes antacids or other drugs can help relieve these symptoms.

Some complications from surgery can be very serious, even fatal. It is important to have a surgeon with experience and a hospital where these operations are done often. Don’t be afraid to ask the surgeon about his or her experience and about the survival rates at the hospital.


Last Medical Review: 12/26/2012
Last Revised: 12/26/2012