Esophagectomy

Stomach and Esophagus

An esophagectomy is the surgical removal of the esophagus. The esophagus is a hollow tube that moves food and liquid from the throat to the stomach. The esophagus was is composed of several layers of tissue, including mucous membrane, muscle, and connective tissue.

An esophagectomy is performed to treat the following conditions:

  1. Advanced cases of Barrett's esophagus, a pre-cancerous condition. Since most patients with Barrett's do not develop esophageal cancer and the operation carries significant risk of complication, esophagectomy is only considered for cases of high-grade dysplasia, a late stage of the condition.
  2. Esophageal cancer that has not spread (metastasized) to other organs in good surgical candidates, healthy enough for the surgery, which is complex and lengthy.

In patients with high-grade dysplasia, the goal of the surgery is remove all of the abnormal Barrett's lining to eliminate the risk of developing esophageal adenocarcinoma and to find and remove unsuspected cancer that may be present in the Barrett's tissue .

In patients with esophageal cancer without metastatic disease, and good performance status, surgery is performed with the intention to cure and to permit patients to swallow.

Esophagectomy at High Volume Centers

Large well-designed studies have shown that patient outcomes in esophagectomy are highly dependent on the number of such procedures performed at the institution where the surgeon operates. Esophagectomy is a technically difficult surgery and the surgeon should regularly perform the procedure in a medical center with experience in the care of these patients.

At high volume medical centers, the mortality rate from esophagectomy is approximately 3-8%. By contrast, the surgical mortality at low volume hospitals is 16-23%. Therefore, patients undergoing esophagectomy should do so only in the hands of an experience esophageal surgeon who regularly performs these procedures in a center of excellence.

UCSF serves as major regional referral center for the multidisciplinary treatment of Barrett's and esophageal cancer. Thoracic and general surgeons work in tandem to perform esophagectomies in high volume with very low peri-operative mortality, each handling one aspect of the surgery, part of a multidisciplinary team of gastroenterologists, medical oncologists and radiation oncologists experienced in the management of patients with esophageal disease.

Surgical Techniques

The two most commonly performed surgeries for are the transhiatal esophagectomy (THE) and the transthoracic esophagectomy (TTE), also known as the Ivor-Lewis Procedure. In both procedures, the patient's diseased esophagus and proximal (top part) stomach is removed. A segment of the stomach is then pulled up into the chest and connected to the remaining normal esophagus, forming a new esophagus.

These surgeries have similar cure and complication rates, each with its own advantages and disadvantages. The type of surgery performed depends on the following factors

  • Age and health of the patient
  • Size and location of the tumor
  • Whether the tumor has invaded other structures in the chest, such as the lungs or large blood vessels

Minimally Invasive Esophagectomy

UCSF is one of a select group of specialty centers performing minimally invasive esophagectomies. This procedure uses tiny incisions and a small scope, through which miniature surgical instruments are passed, connected to a video camera. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the anatomy.

The advantages of minimally invasive esophagectomy include:

  • Less post-operative pain
  • Faster recovery from surgery
  • Shorter hospital stay
  • A more rapid return to work and normal activities
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