Esophagectomy: Everything You Need To Know

An esophagectomy is a surgery performed to remove some or all of the esophagus. The esophagus is the tube that connects the mouth to the stomach through which food travels.

The majority of esophagectomies are performed due to cancer of the esophagus (called esophageal cancer). An esophagectomy is considered major surgery and carries risks, including injury to other organs in surgery, difficulty swallowing or speaking following surgery, and acid reflux, in which stomach acid backs up into the esophagus.

This article will discuss the esophagectomy procedure, what to expect, possible complications, and the recovery process.

What Is an Esophagectomy?

An esophagectomy refers to a surgical procedure in which part or all of the esophagus is removed. The esophagus is a tube that runs from the mouth to the stomach.

During an esophagectomy, some or all of the esophagus is surgically removed and is then rebuilt using part of the stomach, small intestine, or large intestine.

What Are the Risks?

Esophagectomy is a serious procedure and carries some risks.

Short-term risks include:

• Blood clots in the lungs and other parts of the body
• Infections
• Excess bleeding
• Reactions to anesthesia
• Pain following the operation

Other risks include:

• Lung complications like pneumonia, which can be a serious complication that can mean a longer hospital stay or even death
• Voice changes following surgery
• Narrowing in the area where the esophagus connects to the stomach, which can result in problems with swallowing
• Leaks where the stomach connects to the esophagus
• Stomach emptying too slowly following surgery
• Bile and stomach contents rising up into the esophagus following surgery, causing reflux symptoms including heartburn, chest pain, and regurgitation

Some of the complications from an esophagectomy can be life-threatening. It is important you speak with your doctor to understand the risks.

Purpose of Esophagectomy

An esophagectomy may be performed for a number of reasons.

Most commonly, an esophagectomy is needed to treat cancer in the esophagus.

Other reasons for an esophagectomy include:

• Achalasia, a condition that causes a ring of muscle at the end of the esophagus where it connects to the stomach to not relax, preventing the esophagus from contracting
• Severe trauma to the esophagus
• Severe damage to the lining of the esophagus

How to Prepare

Esophagectomy is major surgery and requires preparation. Your doctor will tell you what you need to do to prepare for your procedure.

Leading up to surgery, it is generally recommended that you try to stay healthy and fit. That might mean eating more fruits, vegetables, and lean proteins, and gently exercising regularly if you are able.

If you smoke, your doctor will likely advise you to stop smoking. This will help reduce the risk of infection and leakage from where the stomach attaches to the esophagus in the chest following surgery.

Prior to surgery, you will attend a variety of appointments and will undergo testing. Your doctor will guide you through this process.

What to Wear

If you're going to the hospital for an esophagectomy, it is important you wear comfortable, loose clothing.

You may not be able to wear things you normally do. Most hospitals discourage wearing:

• Contact lenses (Wearing these in surgery can be damaging to your eyes. Wear glasses instead.)
• Jewelry and metal objects, including piercings
• Creams, lotions, makeup, powder, deodorant, cologne, and perfume
• Nail polish or nail wraps
• Tampons (If you are menstruating, wear a sanitary pad.)

Food and Drink

In the month leading up to your surgery, eat a healthy diet.

The day before surgery, you will be asked to fast, consuming a liquid-only diet.

Examples of clear liquids that are allowed include:

• Clear broth
• Gelatin like Jell-O
• Clear fruit juice
• Tea
• Black coffee
• Ginger ale
• Water

During the day before surgery, drink at least one 8-ounce glass of clear liquids hourly when awake.

You will be given instructions about when to start fasting from food and liquids prior to surgery.

Medications

In the lead up to surgery, you may be advised to stop taking certain medications.

A Week Before Surgery

Seven days prior to surgery, you may be advised to stop taking:

• Aspirin or medicines that contain aspirin
• Vitamin E
• Multivitamins
• Herbal remedies
• Dietary supplements

It is important you closely follow the directions of your doctor. Only stop taking the above medications if you are advised to. If in doubt, ask your doctor.

Three Days Before Surgery

Three days prior to your surgery, your doctor may ask you to start taking a medicine called doxazosin that helps lower blood pressure. This may not be necessary for everyone.

Day of Surgery

On the day of surgery, you can take medications as instructed by your doctor with a sip of water.

What to Bring

When going to a hospital for any length of stay, it is important to leave valuable items at home.

You may like to bring a few personal items for comfort before and after surgery. Some items suggested are:

• Shoes that are easy to put on or lace up, in case your feet swell
• Cell phone and charger
• Toothbrush and toiletries
• Sleep apnea devices like a CPAP (continuous positive airway pressure) machine, if needed
• Any personal items you may require like hearing aids, dentures, and their cases

What to Expect the Day of the Procedure

On the day of the surgery, follow your doctor's instructions about taking any medications and arrive at the hospital on time.

Before the Procedure

A number of things will happen when you arrive at the hospital before surgery begins. You will:

• Check in at admitting
• Be asked your name and date of birth many times by many people (this is for your safety)
• Be given a gown to change into
• Meet with a nurse who will review your medications and your medical history
• Meet with the anesthesiologist, the doctor giving you anesthesia for pain and sleep during surgery, who will review your history with anesthesia, review your medical history, and answer your questions
• Have an intravenous (IV) needle placed in your arm or hand to deliver necessary medications and fluids to your bloodstream

During the Procedure

During an esophagectomy, you will be asleep. You will be asked to lie down on the surgical table and will be given anesthesia to put you to sleep.

There are several ways to perform an esophagectomy, depending on how much of the tube needs to be removed. Generally, during the procedure a surgeon will:

• Make incisions in the neck, chest, or abdomen
• Remove part or all of the esophagus
• Join the remaining ends of the esophagus using stitches or staples if only part of the esophagus is removed
• Create a new esophagus using tissue from the stomach if the entire esophagus is removed
• Place a feeding tube into the small intestine to provide nutrition during recovery from surgery, if deemed necessary

After the Procedure

Following surgery, you will typically stay in the hospital for one to two weeks. You may spend time in the intensive care unit (ICU) immediately following surgery.

In the days following surgery you will:

• Have a tube draining fluids out of the side of your chest
• Not be able to eat for two to seven days; once the esophagus has started to heal, you may be allowed liquids
• Be given injections to prevent blood clots
• Wear special socks on your feet to prevent blood clots
• Receive pain medication

Recovery

An esophagectomy is a major surgery, and recovery is a slow process. For some people, it can take months for their digestive system to recover from surgery.

During recovery you may:

• Have some pain
• Have a feeding tube for at least six weeks following your surgery
• Work with a physiotherapist to learn coughing and breathing exercises
• Work with a dietitian to help you learn to eat with your new esophagus

You will likely need help to monitor, clean, and maintain your feeding tube, and check the healing of your incisions. Your healthcare provider will schedule follow-up appointments to check on your healing progress. You may also have a nurse or aide help with your recovery at home.

If you have any concerns during your recovery, you should speak with your doctor.

A Word From Verywell

An esophagectomy is a major surgical procedure that involves removing part or all of the esophagus. This may be performed due to cancer of the esophagus, or trauma to the esophagus. The surgery carries risks, some of which may be life-threatening. Recovery from the procedure can take time. If you have concerns about your health or an upcoming surgery, you should speak with your doctor.