Esophageal Cancer - Esophagectomy
SURGICAL RESECTION
Surgical resection (removal) of
the esophagus is indicated in several types of esophageal abnormalities,
as well as for esophageal cancer. Your surgeon will choose one of
several approaches for the removal of your esophagus and will describe
the specific approach to be used for you.
Surgical Approach
After you have received your epidural for pain control
and are asleep, the surgeon will remove the mass and form a replacement
esophagus out of your stomach. The surgery will take approximately 6
hours. Additional time may be needed before surgery to insert
intravenous lines and put you to sleep. The esophagus and associated
lymph nodes will be sent to pathology for analysis. The final pathology
report usually takes 10 to 14 days. The surgeon will notify you of your
diagnosis as soon as he has the final report. If you have not heard from
him within two weeks, please contact the office.
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ESOPHAGECTOMY
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Left Transthoracic (Chest) Approach
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Ivor-Lewis (Belly and Right Chest)
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Three Hole Esophagectomy
(Right Chest/Belly/Left Neck)
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Transhiatal (No Chest Incision)
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Surgical Approaches
There are four currently used surgical approaches for an
esophagectomy--Transthoracic, Ivor-Lewis, 3-Hole Esophagectomy and
Transhiatal. Approaches are chosen by the surgeon in order for the
esophagus, tumor or obstruction, and lymph nodes to be adequately
removed. Sometimes a neck incision will need to be made instead of an
abdomen incision due to the location of the tumor.
Risks & Potential Complications
Your surgeon will explain the risks and alternatives to
surgery in detail with you. It is an extensive procedure, requiring a
significant about of time under general anesthesia. Every possible
precaution will be taken. The major risks of an esophagectomy are leaks
from the internal suture line, pneumonia or infection, bleeding,
abnormal heart rhythms, and rarely heart attack and death.
Feeding Tube
If you have not previously had a feeding tube placed,
you will have one inserted into your small intestine during the
operation. This will be used to feed you during the time you are not
able to eat by mouth. It will help keep your body in optimal condition
during the postoperative period and will be removed approximately 1
month after surgery.
Chest Tubes
During surgery, one or more chest tubes will be placed
into your side. These chest tubes are used for drainage and to monitor
air leakage. The tube is hooked up to an empty container, which will
collect any fluid that drains out from your chest. The chest tube will
remain in until the drainage stops and there is no air leakage.
Pain Control
Operations create pain. We make every effort to minimize
your discomfort through oral medications, IV medications and epidural
catheters. You will be asked frequently about your pain. Please be
honest. It is very important for the pain to be under control because
taking deep breaths and moving are essential for quick recovery.
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PCA (Patient Controlled Analgesia): This is
pain medicine that is given through your IV. You will be able to
press a button connected to the pain medicine and dose yourself as
needed. You do not need to worry about overdosing or becoming
addicted. Limits will be programmed into the pump and you will not
become dependent while you are having real pain.
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Epidural Catheter: This is a very small tube
placed in your back at the time of surgery. Pain medication is
infused through the catheter, which will bathe the spinal cord and
prevent pain. You may have a PCA button for your epidural pain
medicine (see above).
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Oral medications are most often given on an
"as needed" schedule. This means that you must ask the nurse to give
you the medicine. Usually, there is a 4 hour interval between doses.
Please let your nurse know if you need your medicine more frequently
or if it makes you too sleepy.
Deep Breathing, Coughing & Incentive Spirometry
It is very important to cough and deep breath after
surgery. Your lungs need to be fully expanded to prevent infection and
collapse. Please practice coughing and deep breathing before you come in
for surgery.
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Deep breathing: fill your lungs up slowly
over a count of 5, hold for a count of 5, exhale slowly over a count
of 5. REPEAT 10 TIMES per hour while you are awake.
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Coughing: take two slow breaths filling your
lungs up as much as possible. Begin your cough as you exhale the
second time. Make sure you hold a pillow or towel over your incision
(also called "splinting" your incision) during your cough. This will
decrease the pain. REPEAT 10 TIMES per hour while you are awake.
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Incentive Spirometry: Hold the spirometer
securely in two hands and place your mouth on the mouth piece.
Exhale around the mouth piece and make a tight seal on the
mouthpiece. Inhale slowly to the count of 5 while you watch the disc
move upward. Hold for a count of 5, loosen the seal around the
mouthpiece & exhale. REPEAT 10 TIMES per hour while you are awake.
Activity
Walking and moving frequently are very important
components of your recovery. The more you push yourself to exercise and
move, the quicker and less painful your recovery will be. You may not
feel up to moving, BUT YOU MUST. You will be up in the chair the night
of surgery and walking in your room the next morning.
Nutrition
You will not be allowed to eat or drink ANYTHING for the
first week after surgery. You will have a nasogastric tube (NG tube)
inserted into your nose through your new "esophagus", past the internal
incisions while you are in surgery. NO ONE except your attending surgeon
should remove or reposition this tube. This tube will be attached to
suction & will drain the fluid secreted by your stomach. Your nurse will
flush this tube several times each day to keep it clear. As long as it
is working properly, you should not feel nauseous or vomit. Tell your
nurse if you do feel nauseous.
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You will receive IV fluids for the first week. Any
extra medicines you need will also be given through your IV.
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You will begin feedings through the feeding tube in
your abdomen on the first or second day after surgery. The amount of
these feedings will be increased slowly over the next several days.
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You will have a swallowing test within 7-14 days of
your surgery. You will be given a special liquid to drink while
x-rays are taken. If there are no areas of leaking fluid on the
xrays , your doctor will remove your NG tube and you will be allowed
to take sips of clear liquids. Your diet will be increased gradually
to 6 small SOFT meals each day.
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