What you can expect

Before the procedure

An important aspect of esophagectomy is determining which type of procedure is best for you. To guide that decision, specialists use state-of-the-art imaging techniques, such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging, as well as endoscopy with biopsies, and endoscopic ultrasound-guided fine-needle biopsies during endoscopy.

During the procedure

An esophagectomy involves removing some or most of the esophagus, a portion of the top of the stomach and nearby lymph nodes if cancer is involved. How much of the esophagus and stomach are removed depends on the stage of the cancer and where it's located. In some circumstances, a portion of the intestine — rather than the stomach — may be pulled up and connected to the esophagus.

Depending on your situation, the surgeon will choose one of the following surgical techniques:

• Open esophagectomy. This approach involves making one or more large incisions in the neck, chest or abdomen. The surgeon may choose a transthoracic esophagectomy, in which the esophagus is removed through incisions in the abdomen and chest. Or the surgeon may perform a transhiatal esophagectomy, in which the incisions are done in the abdomen and neck. Occasionally, a neck, chest and abdominal incision is needed and this is called a three-field esophagectomy.
• Minimally invasive esophagectomy. This type of approach involves removing the esophagus through several small incisions in the abdomen (laparoscopically) or the chest (thoracoscopically). During laparoscopic surgery, the surgeon inserts instruments and a camera-tipped device through the incisions to view and perform the operation without dividing the muscles or breaking a rib. In some centers, this procedure may be robot assisted.

After the procedure

Your doctor will likely recommend tube feeding (enteral nutrition) through a small tube placed through your abdomen that connects to the small bowel. This type of feeding will continue for four to six weeks to ensure adequate nutrition while you recover. Once you resume a normal diet, the stomach's reduced size means you will need to eat more frequent, smaller quantities. You may lose weight after surgery.