Surgery may be used to remove the cancer and some of the surrounding tissue, depending on the stage of esophageal cancer. Surgery can also be combined with other treatments, such as chemotherapy and/or radiation therapy.

Esophagectomy

Surgery to remove all or part of the esophagus is called an esophagectomy. Often a small amount of the stomach is removed as well. When the esophagus is removed as treatment for cancer, lymph nodes near the esophagus are also removed. The upper part of the esophagus is then connected to the remaining part of the stomach. Part of the stomach is pulled up into the chest to become the new esophagus. For this procedure, how much of the esophagus that is removed depends upon the stage of the tumor and where it's located.

If a cancer is located in the distal part of the esophagus (near the stomach) or at the place where the esophagus and stomach meet (the gastroesophageal junction or GE junction), the surgeon will remove part of the stomach, the part of the esophagus containing the cancer, and about 8 to10 cm (3 to 4 inches) of normal esophagus. Then, the stomach is connected to what is left of the esophagus either high in the chest or in the neck.

If the tumor is in the upper or middle part of the esophagus, most of the esophagus will need to be removed in order to be sure to get enough tissue above the cancer. The stomach will then be brought up and connected to the esophagus in the neck. If the stomach cannot be used to replace the esophagus, the surgeon may use a piece of the intestine instead. When a piece of intestine is used, it must be moved without damaging its blood vessels. If the vessels are damaged, not enough blood will get to that piece of intestine, and the tissue will die.

Open esophagectomy: There are many different techniques and approaches used in operating on esophageal cancer. The esophagus can be removed with the main incision (cut) in the chest -- this is called a transthoracic esophagectomy. If the main incision is in the abdomen, it is called a tranhiatal esophagectomy. Some techniques involve incisions in the neck, chest, and abdomen. You and your surgeon should discuss in detail the operation planned for you and what you can expect. The surgeon may use pictures to describe how the operation will be done. No matter what approach is used, this is not a simple operation and it may require a long hospital stay.

If the cancer has not yet spread beyond the esophagus, removing the esophagus may be able to cure the cancer. Unfortunately, most esophageal cancers are not found early enough for doctors to cure then with surgery. In patients who can't be cured with surgery, an operation may still be done to help reduce symptoms. Surgery often helps with trouble swallowing, making it easier for them to eat and maintain good nutrition.

Minimally invasive esophagectomy: The esophagus can also be removed through several small incisions instead of 1 or 2 large incisions. This is called a minimally invasive esophagectomy. The surgeon puts a scope (like a tiny telescope) through 1 of the incisions. This allows the surgeon to see everything during the operation. Then the surgical instruments go in through some smaller incisions. In order to do this type of procedure well, the surgeon needs to be highly skilled and with a great deal of experience removing the esophagus under laparascopic guidance. A successful minimally invasive esophagectomy allows the patient to leave the hospital sooner and recover faster. This approach is used most often for early (small) cancers.

Risks and side effects

Like most serious operations, surgery of the esophagus has some risks. A heart attack or a blood clot in the lungs or the brain can occur during or after the operation. There may be a leak at the place where the stomach is connected to the esophagus. This complication is not as common as it used to be because of improvements in surgical techniques. After the operation, the stomach may empty too slowly because the nerves that control its contractions can be affected by surgery. This can, in a few cases, lead to frequent nausea and vomiting.

Infection is a risk with any surgery. Strictures (narrowing) can form where the esophagus is surgically connected to the stomach and cause difficulty swallowing in about 10% to 15% of patients. To relieve this symptom, these strictures can be expanded during an upper endoscopy procedure. After surgery, bile and stomach contents can enter the esophagus because the lower esophageal sphincter is often removed or changed by the surgery. This can cause symptoms such as heartburn. Sometimes antacids or motility drugs can help relieve these symptoms.

Some of these complications may be fatal. The risk of dying from this operation is related to the hospital and doctor's experience with these procedures. In general, the best outcomes are achieved with surgeons and hospitals that have the most experience. This is why patients should not hesitate to ask the surgeon about his or her experience - how often they operate on the esophagus, how many times they have done this procedure, and what percent of their patients have died after this surgery. The hospital where the surgery is done is also important, and any hospital that you consider should be willing to show you survival statistics.

Last Medical Review: 05/04/2009
Last Revised: 05/13/2009