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Surgery may be an option if cancer has grown into the muscles and other tissues that form the wall of the esophagus.
Sometimes NYU Langone doctors perform surgery after treatment with chemotherapy, in which drugs are used to destroy cancer cells throughout the body, or radiation therapy, in which energy beams penetrate the skin to destroy cancer cells in specific locations, or both.
During an esophagectomy, doctors remove part or most of the esophagus and the nearby lymph nodes. Lymph nodes are small glands that trap organisms, such as viruses and bacteria, and are often the first place that cancer spreads.
Surgeons may also remove the top part of the stomach if esophageal cancer has spread there or to help remove a margin, or border, of healthy tissue around the cancer. This helps to ensure that all of the cancer has been removed.
After doctors remove the cancer using one of several techniques, they connect the stomach to the remaining portion of the esophagus directly or using a piece of the small intestine to bridge the gap. The surgical connection between these structures is called an anastomosis.
Depending on the location of the anastomosis, surgeons may need to make incisions in the neck, in the chest between the ribs, or in the upper abdomen during an esophagectomy to access all the affected structures in the body.
Because it’s sometimes not possible to eat a regular diet for several weeks after these procedures, doctors may place a feeding tube directly into the small intestine. This is placed through the abdomen and helps to ensure that you receive adequate liquid nutrition.
This tube is used in the hospital and at home as you recover and start eating again. Our doctors and nurses can show you how to use and care for the feeding tube.
Types of Esophagectomy
Whenever possible, NYU Langone doctors use minimally invasive surgical procedures. With these approaches, doctors make small surgical incisions in the chest, abdomen, or neck to help reduce scarring and recovery time.
Thoracoscopic and Laparoscopic Surgery
With thoracoscopic and laparoscopic esophagectomy, doctors make small incisions in the abdomen, chest, and neck, depending on where the esophageal tumor is and where the anastomosis needs to be placed. They pass a thoracoscope, a thin, lighted tube with a video camera on the end of it, through small incisions in the chest or neck.
At the same time, they may also use a laparoscope, which is similar to a thoracoscope, only it is inserted through incisions in the abdomen. Doctors then place surgical tools through these scopes to perform the esophagectomy.
Physicians at our Robotic Surgery Center were among the first in the New York area to use robotic surgery for esophagectomy.
Robot-assisted surgery is increasingly being used to treat esophageal cancer, because the technique allows doctors to operate without the need for a large abdominal incision. This results in less postoperative discomfort and scarring as well as a faster recovery.
The robotic surgery system is composed of tiny surgical instruments mounted on three separate arms. A fourth arm contains a camera that produces magnified, three-dimensional images on a computer monitor, which guide the surgeon during the procedure.
The surgical tools and camera are inserted through small incisions in the neck, chest, or abdomen. The surgeon controls these instruments and the camera from a console located in the operating room.
Robotic surgery provides doctors with excellent visualization of the cancer and surrounding organs, blood vessels, and nerves, enhancing their ability to perform delicate procedures.
Robotic surgery may result in less bleeding and recovery time than open surgery.
Open surgery involves making larger incisions than those used in minimally invasive surgery.
Although most esophageal surgery at NYU Langone is minimally invasive, making a larger incision may be necessary depending on the size and location of the tumor. It may also be necessary if you have significant scar tissue from previous surgery in your abdomen, chest, or neck.
Recovering from Esophageal Surgery
Hospital recovery time ranges from 5 to 10 days, depending on the type of surgical approach used.
During this time, doctors may perform a barium swallow study to see how the anastomosis is healing and check your ability to swallow. This information can help to determine when to remove a feeding tube, with the eventual aim of getting you back to eating and drinking normally without assistance.
The nutritionists and swallowing therapists at Rusk Rehabilitation can then help you with any difficulty or discomfort associated with swallowing as you adapt to the changes in your esophagus.
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