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Esophageal Cancer Surgery

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Posted 10/13/2014

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Surgeons at The Nebraska Medical Center offer a minimally invasive approach to treating cancers of the esophagus which can allow patients a quicker recovery and nearly normal life after surgery. For more information, call 1-800-922-0000 or visit http://www.nebraskamed.com.

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Esophagectomy is removal of the esophagus. It can be the removal of a portion of the esophagus or, in most cases, it’s almost a complete removal of the esophagus and in a majority of the cases, we replace the esophagus with a tube created from the stomach, so the stomach is actually moved from the abdomen either up into the chest or as we do it up into the neck area.

Almost all of the patients who undergo removal of their esophagus or having it get done are for reasons of esophageal cancer. There are a small number of patients who have it removed for benign diseases, sometimes children or young adults who have a caustic injury may need to have at one point to have their esophagus removed but the great majority are usually lead to cancers of the esophagus.

At least right now, the greatest risk factor for developing esophageal cancer is thought to be chronic gastro esophageal reflux disease. So people who have chronic heartburn or are on medications for the, it’s thought that the combinations of the acids injuring the lining of the esophagus, followed by some of the bile going up into the esophagus, causing changes within the esophagus that wind up leading to esophageal cancer. So with the great billions of people who have gastro esophageal reflux disease, those who are the ones that over the long term will potentially have risk for developing cancer of the esophagus.

Correct, this is also one of the newer procedures that’s come along in the minimally invasive era, where this used to be an operation that was done with incisions in the abdomen, the chest and sometimes the neck and a combination of two or three of those. Now we do the same operation using a combination of minimally invasive techniques, so the modification that we use here has been to go into the chest with the scope and get the esophagus ready for removal from the chest. Now then the surgical oncology team would go in through the abdomen and prepare the stomach into a tube. Once the stomach has been stapled and made into a tube, we then pull it up through the chest and then put the stomach into the esophagus (the small part that’s left behind in the neck together) and that’s what reestablishes a continuity of the GI tract that allows patients to resume eating.
Patients who’ve had their esophagus removed can be expected to live normal lives. There are some modifications; some things that they have to adjust to in terms of size of the meals that they eat and usually not eating right before going to bed. They do tend to have a little bit more in the way of reflux symptoms if they lie completely flat after eating a meal, but otherwise they’re able to maintain their weight, eat all the foods that they want to eat. They usually just have to adjust to a little bit in terms of the volume and when they wind up eating.

This is probably even more uncommon than actually removing parts of the lung with this scope. This requires, usually, a team that’s comfortable with dealing with diseases of the esophagus just to start with, but also having expertise with doing minimally invasive operations, which is again why we do it as usually a two team approach having to deal with the chest and also with the abdomen.

I’m Dr. Rudy Lackner, a thoracic oncologist at The Nebraska Medical Center.