Oesophageal Resection for cancer

Introduction

Oesophagectomy is a surgical procedure used to remove part of the tube between your mouth and stomach (oesophagus) and then reconstruct it using some or all of another organ, usually the stomach.

Indications

Stenosis unresponsive to antacid medications and dilatation.
Past history of multiple unsuccessful antireflux operations.
Persistent stenosis in spite of effective hiatal repair against reflux which suggests the existence of a transparietal fibrosis.
Severe motility disorder of the oesophageal body and sphincter and poor response to dilatations.
Long and narrow stenosis.
Severe periesophagitis at operation.
Concomitant giant Barrett's ulcer.
Concomitant Barrett's high-grade dysplasia.
Suspicion of oesophageal carcinoma.
Oesophageal perforation into the pleural cavity secondary to endoscopic dilatation.

Preoperative Instructions

Stop smocking completely.
Immuno-nutrition is given usually 7 days before the operation.
Full assessment in preadmission clinic in which you will see the anesthetist and discuss all your medications.

Procedure

There are three types of open oesophagectomy that a surgeon might perform:

Transthoracic Oesophagectomy (TTE)

A TTE is performed through the chest. The section of the oesophagus with cancer and the upper part of the stomach are removed. The remaining portions of the oesophagus and stomach are then connected to rebuild a digestive tract. In some cases, part of the colon is used to replace the removed section of oesophagus. Lymph nodes in the chest or neck may also be removed if they’re cancerous.
A transthoracic oesophagectomy (TTE) is used for:

Cancer involving the upper two-thirds of the oesophagus.
Dysplasia in a condition called Barrett’s oesophagus.
Destruction of the lower two-thirds of the oesophagus by swallowing a caustic agent.
Oesophageal stricture.

Transhiatal Oesophagectomy (THE)

During a transhiatal oesophagectomy (THE), the oesophagus is removed without opening the chest. Instead, an incision is made from the bottom of the breastbone to the bellybutton. Another small incision is made on the left side of the neck. The surgeon removes the oesophagus, moves the stomach up to the area in the neck where the oesophagus was removed, and connects the remaining portion to the stomach in the neck.
A transhiatal oesophagectomy (THE) is used to:

Remove cancer of the oesophagus.
Remove the oesophagus after other procedures have been used to treat cancer of the oesophagus.
Narrow or tighten the oesophagus to make swallowing less difficult.
Correct problems with the nervous system.
Repair recurrent gastroesophageal reflux.
Repair a hole or injury caused by a caustic agent such as lye.

En Bloc Oesophagectomy

An en bloc oesophagectomy is the most radical of the oesophagectomy procedures. During this procedure, your doctor takes out the oesophagus, a portion of the stomach, and all of the lymph nodes in the chest and abdomen. The surgery is performed through the neck, chest, and abdomen. Your doctor will reshape the remainder of the stomach and bring it up through the chest to replace the esophagus.
A radical en bloc oesophagectomy is used to treat a potentially curable tumor.

Postoperative Instructions

Your doctor will likely recommend tube feeding (enteral nutrition) 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.