World Library  
Flag as Inappropriate
Email this Article

Esophagectomy

Article Id: WHEBN0002674597
Reproduction Date:

Title: Esophagectomy  
Author: World Heritage Encyclopedia
Language: English
Subject: Digestive system surgery, Pyloromyotomy, Cholecystostomy, Hepatoportoenterostomy, Jejunostomy
Collection: Digestive System Surgery, Surgical Oncology, Surgical Removal Procedures
Publisher: World Heritage Encyclopedia
Publication
Date:
 

Esophagectomy

Esophagectomy
Intervention
Surgical removal of the esophagus.
ICD-9-CM 42.40
MeSH

Esophagectomy (US English) or Oesophagectomy (British English) is the surgical removal of all or part of the esophagus.

Contents

  • Medical uses 1
  • Classification 2
  • Process 3
  • References 4

Medical uses

The principal objective is to remove the esophagus, a part of the gastrointestinal tract ("food pipe"). This procedure is usually done for patients with esophageal cancer. It is normally done to remove cancerous tumors from the body. It is normally done when esophageal cancer is detected early, before it has spread to other parts of the body. Esophagectomy of early stage cancer represents much the best chance of a cure. Despite significant improvements in technique and postoperative care, the long-term survival for esophageal cancer is still poor. Currently multimodality treatment is needed (chemotherapy and radiation therapy) for advanced tumors. Esophagectomy is also occasionally performed for benign disease such as esophageal atresia in children, achalasia, or caustic injury.

In those who have had an esophagectomy for cancer, omentoplasty appears to improve outcomes.[1]

Classification

Diagram showing before and after an oesophago-gastrectomy

There are two main types of esophagectomy.

  • A transhiatal esophagectomy (THE) is performed on the neck and abdomen simultaneously.[2]
  • A transthoracic esophagectomy (TTE) involves opening the thorax (chest).

In most cases, the stomach is transplanted into the neck and the stomach takes the place originally occupied by the esophagus. In some cases, the removed esophagus is replaced by another hollow structure, such as the patient's colon.

Another option which is slowly becoming available is minimally invasive surgery (MIS) which is performed laparoscopically and thoracoscopically.

After surgery, patients may have trouble with a regular diet and may have to consume softer foods, avoid liquids at meals, and stay upright for 1–3 hours after eating. Dysphagia is common and patients are encouraged to chew foods very well or grind their food. Patients may complain of substernal pain that resolves by sipping fluids or regurgitating food. Reflux-type symptoms can be severe, including intolerance to acidic foods and large, fatty meals. Jejunal feeding tubes may be placed during surgery to provide a temporary route of nutrition until oral eating resumes.

Process

Esophagectomy is a very complex operation that can take between 4 and 8 hours to perform. It is best done exclusively by doctors who specialise in upper gastrointestinal surgery. Anesthesia for an esophagectomy is also complex, owing to the problems with managing the patient's airway and lung function during the operation. Lung collapse is highly probable as well as losing function of diaphragm and possible injury of the spleen.

Average mortality rates (deaths either in hospital or within 30 days of surgery) for the operation are around 10% in US hospitals. However, recognized major cancer hospitals typically report mortality rates under 5%. Major complications occur in 10-20% of patients, and some sort of complication (major and minor) occurs in 40%. Time in hospital is usually 1–2 weeks and recovery time 3–6 months. It is possible for the recovery time to take up to a year.

References

  1. ^ Yuan, Y; Zeng, X; Hu, Y; Xie, T; Zhao, Y (Oct 2, 2014). "Omentoplasty for oesophagogastrostomy after oesophagectomy.". The Cochrane database of systematic reviews 10: CD008446.  
  2. ^ Davies AR, Forshaw MJ, Khan AA, et al. (2008). "Transhiatal esophagectomy in a high volume institution". World journal of surgical oncology 6 (1): 88.  
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
 


Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.