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For some earlier stage cancers, surgery can be used to try to remove the cancer and some of the normal surrounding tissue. In some cases, it might be combined with other treatments, such as chemotherapy and/or radiation therapy.
Surgery to remove some or most of the esophagus is called an esophagectomy. If the cancer has not yet spread far beyond the esophagus, removing the esophagus (and nearby lymph nodes) may cure the cancer. Unfortunately, most esophageal cancers are not found early enough for doctors to cure them with surgery.
Often a small part of the stomach is removed as well. 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 or neck to become the new esophagus.
How much of the esophagus is removed depends upon the stage of the tumor and where it’s located:
Esophagectomy can be done in different ways. No matter which technique is used, esophagectomy is not a simple operation, and it may require a long hospital stay. It is very important to have it done at a center that has a lot of experience treating these cancers and performing these procedures.
Open esophagectomy: In the standard, open technique, the surgeon operates through one or more large incisions (cuts) in the neck, chest, or abdomen (belly).
You and your surgeon should discuss in detail the operation planned for you and what you can expect.
Minimally invasive esophagectomy: For some early (small) cancers, the esophagus can be removed through several small incisions instead of large incisions. The surgeon puts a laparoscope ( a thin flexible tube with a light) through one of the incisions to see everything during the operation. Then the surgical instruments go in through other small incisions. To do this type of procedure well, the surgeon needs to be highly skilled and have a lot of experience removing the esophagus this way. Because it uses smaller incisions, minimally invasive esophagectomy may allow the patient to leave the hospital sooner, have less blood loss, and recover faster.
For either type of esophagectomy, nearby lymph nodes are also removed during the operation. These are then checked in the lab to see if they have cancer cells. Typically, at least 15 lymph nodes are removed during surgery.
If the cancer has spread to the lymph nodes, the outlook is not as good, and the doctor may recommend other treatments (like chemotherapy and/or radiation) after surgery.
Like most serious operations, surgery of the esophagus has some risks.
Some complications from this surgery can be life threatening. The risk of dying from this operation is related to the 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 ask the surgeon about their experience: how often they operate on the esophagus, how many times they have done this procedure, and what percentage 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 their survival statistics.
Sometimes minor types of surgery are used to help prevent or relieve problems caused by the cancer, instead of trying to cure it. For example, minor surgery can be used to place a feeding tube directly into the stomach or small intestine in people who need help getting enough nutrition. This is discussed in Palliative Therapy for Esophageal Cancer.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Ku GY and Ilson DH. Chapter 71 – Cancer of the Esophagus. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa. Elsevier: 2020.
National Cancer Institute. Physician Data Query (PDQ)-Health Professional Version. Esophageal Cancer Treatment. 2019. Accessed at https://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq on Jan 14, 2020.
National Cancer Institute. Physician Data Query (PDQ)-Patient Version. Esophageal Cancer Treatment. 2019. Accessed at https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq#_159 on Jan 14, 2020.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Esophageal and Esophagogastric Junction Cancers. V.4.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf on Jan 14, 2020.
Posner MC, Goodman KA, and Ilson DH. Ch 52 - Cancer of the Esophagus. In: DeVita VT, Hellman S, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott-Williams & Wilkins; 2019.
Last Revised: March 20, 2020
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