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Esophagectomy

What is it?

Esophagectomy surgery involves the removal of part or all of your esophagus (swallowing tube). Your esophagus allows food to travel from your mouth to your stomach.

Why?

The most common reason for removing your esophagus is cancer. Sometimes the esophagus may be scarred or damaged from other causes that make it necessary to remove it.

Preoperative Evaluation

Esophagectomy surgery is major surgery. You will need to undergo several tests before surgery in order to make the procedure as safe as possible. You may require some or all of the following:

Within 4 weeks of your surgery, you will be assessed in the Pre-Admission Clinic at London Health Sciences Centre's (LHSC) Victoria Hospital, located in Zone C Level 2, room C2-600.

Procedure

The procedure is done through several incisions (cuts). The type of incisions depend on the size and location of the disease in your esophagus. There is usually an incision in your neck and abdomen and sometimes an incision in your chest, between the ribs. The esophagus is removed and the stomach is pulled from the abdomen up to the neck.

Risks

As with all major chest surgery, there are risks. Some of these include bleeding, infection, leaks from an incision, heart attack, irregular heartbeats, stroke, blood clots to the lung, and sometimes death.

Before Surgery

Drink only clear liquids for 2 days before your surgery. You will be given a prescription for a drink to help clean out your bowels the day before surgery.

DO NOT EAT OR DRINK ANYTHING, including water, after midnight the night before the procedure unless instructed otherwise by your surgeon. Leave jewellery and other valuables at home.

Day of Surgery

You must report to the Admitting Department at Victoria Hospital located in Zone B Level 2 (B2-100) , two hours before your scheduled operation. You will be directed to the Perioperative Care Waiting Room, Zone D Level 2, Room D2-100 where you wait until a nurse calls for you.

After Surgery

You will wake up in the post anesthesia care unit (P.A.C.U. or recovery room). A breathing tube may be in your mouth to help with your breathing. Once you are awake and able to breathe on your own, the breathing tube will be removed and you will be transferred to the Thoracic Observation Unit.

You will have many tubes. Some will be coming from your nose, neck, chest (chest tubes), abdomen (feeding tube), bladder, and arms (IVs). Most patients will also have an epidural in their back for pain control. Most of these tubes will remain in place for 5-7 days.

Family and friends may wait in the Perioperative Care Waiting Room, Zone D Level 2, Room D2-100. Your surgeon will come to speak with them following the surgery.

Pain

There is moderate to severe pain with this surgery. A variety of methods are used to control the pain. You may receive an epidural which delivers pain medication directly to the spinal cord, or an intravenous that you control to give yourself medication (PCA). Many of these are started in the operating room before the procedure to help decrease the pain immediately after surgery.

While in the Thoracic Observation Unit, your heart and oxygen level will be monitored very closely, along with the drainage from your tubes. Your bed will be tilted to a 30 degree angle to reduce the regurgitation of stomach contents.

You will not eat for at least 7 days after surgery. You will, however, be fed through a tube into your abdomen. After 6 or 7 days, you may undergo a barium swallow test to check that everything has healed. If there are no leaks, the tube in your nose will be removed and you will be given a liquid diet. Over the next few days, your diet will be advanced to solids.

To prevent blot clots from forming in your legs, you will be given a blood thinner (heparin) as an injection twice a day. You may also be asked to wear special compression stockings.

Discharge

The average length of stay is 7 to 10 days. You will go home with a feeding tube in your abdomen. It will be removed after all additional (if any) treatment is complete. Home care support will be provided to assist with the care of the feeding tube.

Dressings

A bandage will cover the sites where the chest tubes were. This bandage should be kept dry and left in place for 2 days. After 2 days, remove the bandage and gently wash the wound with a mild soap in the shower. Do NOT take a bath. Further dressings are not needed, but you may cover the wound with dry gauze if there is any drainage from it.

Diet

You should eat 6 small meals instead of 3 large meals per day. To avoid bloating and cramping, you should separate the liquids from the solids. Our dietician will give you detailed instructions about your diet.

Activity

You are encouraged to do your regular activities except:

• No heavy lifting for 6 weeks
• Do not drive a car for 2 weeks
• No swimming or bathing

Remember to keep your head elevated at all times

Prescriptions

You will be given a prescription for pain medication and a stool softener to prevent constipation. Additional prescriptions will be given if needed.

Follow-up

Before you leave the hospital, your nurse will schedule a return appointment with your surgeon. This will be in 6 weeks time. The final pathology results will be discussed during this appointment.

Call your surgeon's office if:

1. You have any excess
   • bleeding
   • drainage from any wounds
   • pain
   • difficulty swallowing
   • vomiting

2. You have a temperature of 38.5° C (101.5° F)
   
   
3. Your prescriptions run out
   
   
4. You have any questions