An esophagectomy is a surgical procedure to remove a portion or all of someone’s esophagus, the tube located between the mouth and stomach. Cancer of the esophagus is the primary reason doctors recommend this operation.

What happens during an esophagectomy?

The goal is to remove the diseased esophagus and replace it with another organ, most commonly the stomach.

Patients are under general anesthesia for an esophagectomy. Typically, a surgeon will make two incisions – one in the upper abdomen and the other in the neck. Using those two incisions, the surgeon dissects the esophagus. He or she then brings the stomach up through the chest to create a new connection in the neck.

Recovery often takes 3-4 months.

“Most patients have a feeding tube for the first one or two months as they relearn how to eat adequately and maintain weight,” said Dr. Jessica Wernberg, Marshfield Clinic Health System surgical oncologist. “Oftentimes, patients will lose up to 10% of their body weight, but we try to help them progress by recommending small, frequent meals.”

Risks and benefits

Marshfield Clinic Health System has been doing esophagectomies for at least three decades. The safety continues to advance with improved surgical and hospital care. However, as is the case with any procedure, there are risks.

“The biggest concern is related to the new connection between the stomach and esophagus,” Dr. Wernberg said. “This can leak, which can potentially lead to sepsis or scarring, making it difficult for patients to swallow.”

But clearly the primary benefit is the potential cure of esophageal cancer or other disease. Patients can have an improved quality of life after esophagectomy and return to a more normal lifestyle.

The complexity of cancer

Like many cancers, treatment plans for esophageal cancer will be determined on a case-by-case basis. Esophageal cancer may need any combination of surgery, chemotherapy and radiation therapy. As a result, esophageal cancer requires teamwork from multiple specialties, including gastroenterology, surgical, medical and radiation oncology, along with many others. These teams do a lot behind the scenes to work together and improve patient experience and outcomes.

“At Marshfield Clinic Health System, I moderate a weekly gastrointestinal (GI) tumor conference for patients with complex GI issues,” Dr. Wernberg said. “Discussions with our multidisciplinary group enhance communication between providers so we can optimize planning and treatment recommendations.”