How does esophagectomy take place?

The article is professionally consulted by Master, Doctor Duong Xuan Loc - Gastroenterologist - General Surgery Department - Vinmec Danang International General Hospital

Esophageal cancer is the most common cancer today, with an increasing incidence of this disease. The treatment for patients with esophageal cancer is esophagectomy. If detected at an early stage, when cancer cells have not spread, partial or total esophagectomy can treat cancer.

Esophageal cancer is the most common type of cancer today, ranking 5th in gastrointestinal cancer. Esophageal cancer is a disease in which malignant tumors arise from the epithelial cells of the esophagus, causing the cells not to divide according to the structure of the body. Common symptoms in patients with esophageal cancer are difficulty swallowing and severe weight loss. The incidence of esophageal cancer is three times higher in men than in women. For patients with advanced esophageal cancer, the doctor will choose the method of surgery to remove the esophagus, which can be partially or completely combined with other methods such as chemotherapy, radiation therapy. If the malignancy is located in the lower esophagus, the doctor will remove part of the esophagus with cancer cells and part of the stomach, along with a 15-20cm segment of the normal esophagus above. If the tumor is located in the upper or middle part of the esophagus, the doctor will perform surgery to remove the entire esophagus to ensure that all tissue containing cancer cells is removed.

Esophagectomy can be done in 2 ways:
2.1 Open esophagectomy The doctor performs an esophagectomy through a large cut in the neck, abdomen, or chest. The surgery can be performed by different approaches such as: Transthoracic esophagectomy (the esophagus is removed through the main incisions located in the abdomen and chest), through the diaphragmatic slit (the esophagus is removed through the thorax). main incisions are in the abdomen and neck) or through incisions in the neck, abdomen, or chest.
2.2 Laparoscopic esophagectomy The endoscopic treatment of the esophagus will help remove all the lymph nodes, endoscopic esophagectomy. This method is often chosen by doctors because of its high efficiency. Before the surgery, the patient will be anesthetized. After esophagectomy and mediastinal lymphadenectomy, the right bronchial artery was preserved, the two dissected esophageal segments were sutured, and a pleural drain was placed, and ventilation opened the right lung.
The patient will continue to have abdominal surgery to remove the lymph nodes around the stomach and create a gastric tube to replace the esophagus. All are done by endoscopy. A small camera helps the surgeon see everything during surgery. Then, the doctor will make a small incision in the left neck to surgically dissect the cervical esophagus.
The esophagus containing the tumor and the gastric tube were pulled back up through the mediastinum out to the neck. To perform endoscopic esophagectomy, the surgeon must be highly qualified and experienced. Performing laparoscopic surgery helps patients reduce the risk of infection and recover faster. Patients with esophageal cancer can be cured by removing the esophagus and adjacent lymph nodes when the cancer cells have not spread to other parts of the body.
When performing an open or laparoscopic esophagectomy, adjacent lymph nodes should also be removed. The doctor will then conduct tests to see if the lymph nodes contain cancer cells. If they contain cancer cells, it means the tumor has spread to other parts of the body. This helps the doctor come up with suitable treatment options for each patient, often at this stage, esophagectomy will be accompanied by other treatments such as chemotherapy or radiation.
Depending on the specific case, the number of lymph nodes to be dredged will vary. The surgeon can dredge the lymph nodes around the stomach.

Esophagealectomy can cause some complications such as:
Patients have side effects of drugs after surgery, bleeding or infection. Often have lung complications, such as pneumonia, which can lead to a long hospital stay, which can even be fatal. The patient may experience voice changes. Leaking mouth. The narrowing of the esophageal junction makes it difficult for the patient to swallow. Patients often feel nausea, vomiting because the stomach digests food slowly because the nerves that control contractions are affected after surgery. After surgery, the lower esophageal sphincter is often removed and changed by surgery, causing bile and gastric juices to back up into the esophagus, causing heartburn symptoms. In some cases, instead of surgery to treat the disease, the doctor will choose minor surgery to relieve the problems caused by cancer.