Procedures

Esophagectomy

• Description
• Transhiatus esophagectomy
• Ivor-Lewis Esophagectomy
• Laparoscopic esophagectomy or minimally invasive esophagectomy
• Traditional open esophagectomy
• Risks
• Pre operative information
• Day of surgery

• Length of recovery
• Post operative information

Description:
Esophagectomy (surgery) is a common treatment for esophageal cancer. A portion of the esophagus and the stomach is surgically removed. The esophagus is the reconstructed with part of the bowel in the abdomen. The most common replacement for the reconstruction is with part of the stomach. Occasionally, a segment of large bowel and small bowel is used. The procedure that you have will depend on how far your cancer has spread and the stage of the cancer.
Transhiatus esophagectomy:

This consists of approach from the abdomen and a left neck incision.This avoids an incision in the chest and therefore may potentially decrease post-operative pain and perhaps fasten recovery.
Ivor-Lewis Esophagectomy:
This consists of approach from the abdomen and the right chest. This approach may be safer for patient who had significant amount of scarring from their neoadjuvant chemoradiation therapy or previous esophageal surgery.
Laparoscopic esophagectomy or minimally invasive esophagectomy:
In recent years, Dr. Swee H Teh had brought the technique of advanced laparoscopic esophagectomy to the Northwest Specialty Clinics Cancer Care Alliance and Sacred Heart Medical Center. We can now, routinely, performed this minimally invasive surgery through small incisions. Using specialized techniques, cameras with microscopes and high-definition monitors, surgeons can perform surgery through incisions that requires only a stitch or two to close. The improvements in surgical techniques have resulted in marked improvements in patient outcomes over recent years. Patient typically stays in hospital for about 7 days post operatively. Laparoscopic esophagectomy tends to be associated with less postoperative pain, allowed early ambulation and earlier return of patient functional and physical ability.
Traditional open esophagectomy:

Open eosphagectomy is still considered a good operation for management of patient with esophageal cancer. Patients typically stay in the hospital for about the same duration of time. Patients usually take 4 to 6 weeks after surgery to recover.
Risks:
The significant risks for esophagectomy are: esophageal leak, delayed gastric emptying, weight loss, gastric reflux, pneumonia, empyemia, atrial fibrillation, heart attack, wound infection, bleeding, and internal hemorrhage.

Pre operative information:
Before your surgery, you will be required to have a pre admission testing appointment. At this appointment, you will be registered at the hospital; you will have lab work done and possibly a x-ray. You will also meet with an anestheologist.
Day of surgery:
No food starting midnight the night before surgery. Solid food must be avoided the day of surgery-regardless of the surgery time. Clear liquids must be stopped four (4) hours before your surgery.

Clear liquids are considered: water, apple juice, cranberry juice, black coffee (no cream), tea, and soda (7-UP, pepsi, ect).

Length of recovery:
Patients are usually discharged from the hospital 7 days after surgery.
Post operative information:
The following information is intended to guide you through your post-op recovery:
Diet:
For the first few days after your return home you should follow the post operative diet outlined by your surgeon.
Medications:
Follow the directions on any new prescriptions that your doctor has given you. You will be instructed prior to your discharge about what daily medications you will need to take when you return home.
Pain management is an important part of your post-surgery care. You should expect some discomfort after your surgery. You may be sent home with a prescription for pain medication. It is important to take your pain medicine prior to your pain becoming intense in severity.
PLEASE NOTE: No pain medication refills will be authorized on the weekends. If a refill is needed, the request must be made before 12:00 on Friday.
Some side effects from the pain medications include nausea and constipation. If you experience nausea or vomiting related to your pain medications, you should stop the medication and take ibuprofen or acetaminophen for pain management.

Bowel Care:
To prevent constipation you should drink plenty of fluids and take a stool softener daily.
If you have not had a bowel movement within 48 hours after your return home, you should increase your fluid intake. You may take one single dose of Milk of Magnesia, as long as you have no abdominal distention.

Incision Care / Drain Care:
You must observe your incision daily for signs or symptoms of infection. These signs would include: increased swelling, redness or smelly wound drainage. It is normal to have some swelling and bruising around your incision. It is normal to have a firm lump directly beneath your incision line. This will disappear within a couple of months.
If you have staples or stitches, they will usually be removed 2 weeks after your surgery. You will need to make an appointment to come to the office for that.
After the staples are removed you will have skin tapes / steri-strips across the incision. Those strips should remain in place for 5 to 10 days. The strips will gradually loosen and come off. If they do not come off within two weeks you may remove them yourself.

Physical Activity:
Upon your return home you should begin a daily walking program that will gradually increase. You should start walking inside your home initially and then gradually increase to walking around your neighborhood. Every patient will have to individualize their walking according to their general status.
You may resume sexual activity when it is comfortable.
Bathing and Showering:
You may start showering 48 hours after your surgery. You may shower with your steri-strips and staples or stitches in place. Do not scrub across your steri-strips or staples. Do not bathe in a tub for 10-14 days after your surgery. This includes a “hot tub”.

Driving:
You may drive when you no longer are taking narcotic pain medications and you feel you can quickly respond to situations that will not place others in jeopardy.

Return to Work:
As a general guideline the following will give you a guide for when to return to work:
Light lifting or no lifting type jobs: You may return to work the within three to seven days of surgery.
Heavy lifting or physical type jobs: You may return to work within one to two weeks after surgery.
Please notify our office if you need a return to work letter to your employer. It may take up to 48 hours for the letter to be completed. Please leave a fax number for your employer so we can fax your release

Pathology Results:
The pathology results will usually be available two-three “working” days after your surgery. You should call the office in the afternoon, on your third post-op day, if you have not heard from our office.

NOTE:

Follow-up Appointments:
You will need to return to the office for a follow-up visit usually within 7-10 days after your surgery. Please make sure you have your appointment scheduled.

Problems to Observe For:

Call the office for the following:
1. Fever >101.0
2. Uncontrolled pain. That is on a scale of 1-10 (10 being the worst pain imaginable) your pain is a level 7 or above.
3. Nausea and / or vomiting that continue for 12-24 hours.
4. Diarrhea that continues for 12-24 hours.
5. Signs of a wound infection.
6. Chest pain or difficulty breathing
7. Your incision separates or opens up.

If you have further questions after reading this handout, the office is open from 9:00AM to 5:00PM Monday through Friday. For emergencies after office hours, the answering service will be available when you call the office number.