What is esophagectomy?

An esophagectomy (say "ee-sof-uh-JEK-tuh-mee") is surgery to remove all or part of the esophagus. The esophagus is the tube that carries food from the throat to the stomach. Nearby lymph nodes and other tissue may also be removed. The doctor connects the remaining healthy part of the esophagus to the stomach so that you can still swallow and eat food. This surgery is mainly used to treat esophageal cancer. But it can also be used for other problems with the esophagus.

Esophagectomy may be "open" or "laparoscopic." Open surgery is done through cuts in the belly and the upper chest or neck. These cuts are called incisions. Laparoscopic surgery is done through several small cuts. The doctor puts a lighted tube, or scope, and other surgical tools through small cuts. The doctor is able to see your organs with the scope.

You have to be very careful about what you eat for 1 to 2 months after surgery and maybe for the rest of your life. You may have a feeding tube (J-tube) in your belly when you go home. This is to be sure you get enough nutrition. This will come out when you are able to eat normally. How long this takes varies. For many people, it takes 4 to 6 weeks after surgery. Your doctor will give you detailed information on your diet and how to use the J-tube.

You may feel weak after surgery. Take good care of yourself. Get enough rest and stay active. This can help you heal faster. You will probably need to take at least 6 to 12 weeks off from work. This depends on the type of work you do and how you feel. You will need more time to get better if you need other treatment for cancer, such as chemotherapy.

Activity

• Rest when you feel tired.
• Be active. Walking is a good choice.
• You may be able to take showers (unless you have a drain in your incision). If you have a drain, follow your doctor's instructions to empty and care for it. Keep your feeding tube taped to your skin so it will not fall off. Do not soak in a tub or use a hot tub.
• Do not lean your head back quickly or for a long period of time. This puts pressure on the neck and may slow your healing.
• You can do your normal activities when it feels okay to do so.
• Allow your body to heal. Don't move quickly or lift anything heavy until you are feeling better.
• Ask your doctor when you can drive again.

Diet

Your diet will go from a clear liquid diet, to a full liquid diet, and then to a soft diet before you can eat normally. This generally takes 1 to 2 months. Your doctor will give you specific information about what you can eat. In general:

• If you are on a clear liquid diet, eat or drink clear, fat-free broth or bouillon soup. You can also eat flavored ice pops and fruit-flavored gelatin, like Jell-O.
• If you are on a full liquid diet, you can have everything on the clear liquid diet. You can also have creamy soups, cooked cereals, milk, protein shakes, fruit juices, puddings, and ice cream.
• If you are on a soft diet, eat foods that are easy to swallow and digest. These include:
  • Most cereals.
  • Scrambled eggs and omelets.
  • Canned or cooked fruits.
  • Finely ground beef, chicken, turkey, and pork.
  • Mild cheeses.
  • Mashed potatoes.
  • Cooked or pureed vegetables.
  • Yogurt.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Read and follow all instructions on the label.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision, leave the tape on until it falls off.
• Gently run warm, soapy water over the area, rinse, and pat it dry. Your doctor will tell you how to take care of this. Don't use hydrogen peroxide or alcohol, which can slow healing.
• You may cover the area with a gauze bandage if it oozes fluid or rubs against clothing. Change the bandage every day.

Other instructions

• It is normal to have some yellowish mucus around your feeding tube. This is not a sign of infection.
• Keep your feeding tube clamped unless you are using it.
• Keep the tube taped to your skin at all times, and leave some slack in the tube. This helps prevent pain and keeps the tube from coming out.
• If you are using your feeding tube:
  • Clean around the tube with water before and after you use it.
  • Flush the tube as often as your doctor tells you to.
  • Do not put any pills through the tube. They can clog it.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

An esophagectomy (say "ee-sof-uh-JEK-tuh-mee") is surgery to remove all or part of the esophagus. Your doctor made large cuts in the belly and the upper chest or neck to do the surgery. Where the cuts are depends on where the problem was.

When you leave the hospital, the area around the cuts (incisions) may still be swollen or bruised. It may also feel numb. This is normal and may continue for a few weeks. You will probably need to take pain medicine for a few weeks.

You will have to be very careful about what you eat for several months after surgery and maybe for the rest of your life. You will probably have a feeding tube (J-tube) in your belly. This will come out when you can eat normally and get enough nutrition. This could be about 4 to 6 weeks after surgery, but it could take longer. Your doctor will give you detailed information on what you can eat, how you should eat, and how to use the feeding tube.

You may also have digestive problems for a few months. These include weight loss, a lot of gas, and a problem called dumping syndrome. Dumping syndrome usually occurs after you eat rich or fatty meals. It may cause you to feel lightheaded or sick to your stomach, or to have cramps and diarrhea.

Most people go back to work or their normal routine after 6 to 12 weeks. You will need more time to get better if you need other treatment for cancer, such as chemotherapy. It will take 3 to 4 months to get back to your usual activities.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Follow your doctor's instructions about when to bathe or shower before your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take 3 to 8 hours.