Esophagectomy is a surgical procedure to remove some or all of the swallowing tube between your mouth and stomach (esophagus) and then reconstruct it using part of another organ, usually the stomach. Esophagectomy is a common treatment for advanced esophageal cancer and is used occasionally for Barrett’s esophagus if aggressive precancerous cells are present. An esophagectomy may also be recommended for noncancerous conditions when prior attempts to save the esophagus have failed, such as with end-stage achalasia or strictures, or after ingestion of material that damages the lining of the esophagus.

There are different ways to perform esophagectomy surgery. Your surgeon will talk with you about which one is best for you.

• During an Ivor Lewis esophagectomy, also known as a transthoracic esophagogastrectomy, incisions (surgical cuts) are made in the center of your abdomen (belly) and in the back of your chest. After the tumor is removed, your stomach is reattached to the remaining part of your esophagus.
• During a transhiatal esophagectomy, your esophagus is removed through 2 incisions, one in your neck and one in your abdomen. After the tumor is removed, your stomach is attached to the remaining part of your esophagus through the neck incision.
• During a 3-hole esophagectomy, incisions are made in your abdomen, neck, and right upper back.
• During a minimally invasive esophagectomy, in exceptional early stages of the disease,  a tiny camera called a laparoscope is inserted into your belly and chest through multiple small incisions in your abdomen and back, below your shoulder.

Before Surgery:

As with any major surgery, there are pre-operative tests that must be taken in order to ensure the patient is ready for surgery. These tests make certain that your physician knows as much about your condition as possible which ensures the procedure will be performed as safely as possible. Some of these tests may include: (see the Diagnostic Test section for more details)

• Blood Work
• Esophageal Ultrasound
• Cardiac Assessment
• CT Scan
• PET scan
• Gastroscopy
• Pulmonary Functions Test
• Thoracic Surgery Lung School

Please notify our office or the admitting nurse upon arrival to surgery of any changes in your health after your Pre-Op History and Anesthesia assessment were finalized.  

You MUST NOT EAT OR DRINK anything after midnight the night before your surgery, only clear fluids (such as clear tea, black coffee, apple juice, ginger ale, Jell-O) may be consumed up to 4 hours before your admission time. Morning pills can be taken with a very small sip of water up until two hours before your admission time (NO milk, NO orange juice), after this time no fluids are allowed (not even water). Please be aware that this includes gum, candy and mints.

Day of Surgery:

Take your usual medication the morning of your surgery with a SIP of water unless instructed not to by your doctor. Please take a shower or bath and remove all make-up and nail polish and tie your hair back if it is long. Wear comfortable clothing which will be easy to put on after your surgery and wear your hearing aid and glasses instead of contacts.

Please leave all cash, valuables and jewelry at home, since there are no lockers and the hospital assumes no responsibility for patient valuables.

Please bring with you:

• Your surgical package with all the papers completed inside
• Your Ontario Health Card or a list of all your current medications (including herbal remedies). Please include dosage and times taken per day.
• If you are currently taking any puffers, or nitroglycerine (pills or spray), please bring them as you may be asked to use them just before your operation.
• We ask that you bring a tote bag with your clean bathrobe and slippers and since you will be staying overnight bring your toiletries. Anything else you might require during your hospital stay should be brought by family members after your operation.

Upon arrival to the hospital please proceed to Same-Day Admit on the East end of the 2nd Floor of Southlake Regional Health Centre. After registering, your family and friends will be asked to wait in the Surgical Admissions Waiting room on the 2nd Floor during your procedure.

Estimated length of stay in hospital will be approximately 6-9 days after the surgical procedure for the vast majority of patients. 

Patients are discharged home with homecare arranged including in most cases physiotherapy, dietitian, nursing, and possibly even a personal support worker. 

20-25% of patients require prolongation of admission secondary to a variety of issues. 

Anastomotic leaks affect approximately 10% of patients.  Fortunately, this results only in a short prolongation of admission in the vast majority of cases with antibiotic treatment and limitation of oral intake.  However, approximately 3% of patients develop a major anastomotic and/or gastric pull-up issue which can result in a substantial prolongation of admission measured in the order of months and often requiring multiple surgical and/or radiological procedures for management, and certainly is most life-threatening.  Another risk with an esophagectomy is aspiration, both minor and major, associated with the gastric pull-up.  Major aspiration is a significant issue, both short term and long term after surgery, especially in light of potential sedation and/or pain management.  A major aspiration event would result in a significant prolongation of admission measured in the order of multiple weeks for recovery.  This is the second most common contributor to mortality in our patients.  For this reason, after discharge home, it is imperative that ongoing elevation of the head of the bed be followed and that meals within a couple of hours of going to bed be avoided.

Esophagectomy is a major surgical intervention and as such carries with it the usual risks associated with this extent of surgery such as bleeding resulting in a need for transfusion affecting less than 1% of patients, cardiac events, embolic phenomena, anesthetic reactions, drug reactions, etc. affecting approximately 10-15% of patients. Rare complications associated with esophagectomy include chylothorax (leakage of fats from intestine into chest) and hoarseness due to laryngeal nerve injury. the postoperative period pain can be quite difficult from the thoracotomy and abdominal incisions.  In most cases patients require narcotic analgesia for up to 6 weeks to 2 months after the intervention, but fortunately less than 15% of patients require narcotic medication beyond 3 months, less than 10% after 6, and less than 5% after a year. 

Chronic pain associated with any major surgical intervention affects approximately 1-3% of all patients.

Oral intake after discharge is somewhat limited and therefore most patients are discharged home with jejunostomy feeds. Progression of diet is followed by the home care team. Patients are to see their family doctor within one to two weeks of discharge to assist in their ongoing care. Follow up at York Thoracic Surgery will be 4-6 weeks post discharge most often preceded by a gastroscopy before that recheck visit.