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What is Esophageal Cancer Surgery and what are the risks?

Esophageal cancer surgery is also referred to as an esophagectomy.

The first part of the word (esophag) means the esophagus or swallowing tube and the second part of the word (ectomy) means to remove. It means to remove the esophagus. So any time you hear of a surgery with an (ectomy) on the end of it you'll know that it is removal of something.

Esophageal cancer surgery (in the medical system) is one of the last end treatments for esophageal cancer or surgery for esophageal stricture that has turned into cancer. This surgery is also referred to as esophageal and stomach cancer surgery.

Before surgery is considered as an option, a diagnosis must be made of the esophageal cancer, This is done through different diagnostic procedures and tests.

One of the procedures is an esophagealgastroduodenoscopy to look at the inside of the esophagus, stomach and duodenum, and biopsies taken to assess the status. I'll break down this big word for you.

  • esophageal (esophagus)
  • gastro (stomach)
  • duodeno (duodenum) bowel connected to lower stomach
  • scopy (scope) endoscope

Another simple word for it is plain old Endoscopy. The Doctor looks with a scope from the esophagus, stomach and duodenum and then back up taking biopsies (samples of tissue) along the way.

Esophagectomy (removal of the esophagus) during esophageal cancer surgery, is done in two different ways. One is by what is referred to as Open esphagectomy where the neck to the chest is opened in a few long incisions to visually look at and access the stomach, chest and esophagus.

The other approach is what is called Minimally invasive esophagectomy where the surgeon accesses the esophagus through small incisions and then works with a scope. He uses long surgical instruments to go through small incisions other than the scope incision to manipulate the tissues and esophagus. The surgeon needs to be very skilled for this type of approach.

The Doctor will have planned before the surgery and discussed it with his patient how he will replace the cancerous esophagus.

These are some ways to replace the diseased esophagus.

  • cut out the cancerous esophagus, and part of the diseased stomach if cancerous and connect the remaining esophagus to the remaining stomach. Part of the stomach will then be in the chest.
  • use part of the patients bowel to replace the esophagus.
  • use a synthetic graph to replace the diseased esophagus.

The Doctor will discuss in detail with both he and the patient to make the best decision on the surgery.

If the stomach is diseased and partially removed with the esophagus then after surgery bile and stomach contents can enter the esophagus because the lower esophageal sphinter has been removed by surgery. This can cause sypmtoms like heartburn.

Risks for surgery include:

  • infection
  • heart attack or blood clots in the brain or lungs
  • lung complications
  • leaks at suture areas
  • strictures where esophagus is connected to the stomach
  • some of these complications may be fatal

There are new surgeries for acid reflux and techniques for esophageal cancer surgery coming out every year especially with the digital equipment and diagnosing.

Radio frequency ablation is a fairly new treatment that is promising for certain stages of pre-cancerous and cancerous conditions.

The American Cancer Society and Mayo clinic are good references for state-of-the-art surgical information.

American Cancer Society website

Mayo Clinic Website

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