Ricker Polsdorfer, MD
Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.
To treat esophageal cancer, an
may be done in an effort to remove some or all of the cancerous tissue. Other invasive procedures may be done to help provide nutrition when the esophagus shuts down. These include
placing a feeding tube
maintaining a channel through the esophagus. These last two procedures are referred to as palliative, because their goal is to relieve symptoms, not to cure the cancer.
Psychotherapy may have an important role to play in the care of patients admitted to the hospital for esophageal cancer surgery. Researchers randomly divided 271 surgical patients with cancers affecting the gastrointestinal tract (
colon, or rectum) into two groups: one received usual care on the surgical ward and the other received formal psychological support in addition to usual care. Psychological interventions, which were provided both before and after surgery, consisted of emotional and cognitive support and help in planning for the future. Ten years after their surgery, patients who received psychological support were significantly more likely to be alive than those who did not receive such additional care.
Esophagectomy is the complete removal of the diseased portion of the esophagus and all associated tissues that might contain cancer. This surgery is not even considered in 60% of cases. Even when it is attempted, the procedure is frequently unsuccessful and has a high mortality rate immediately following surgery that accounts for 5% to 10%. This is due to the frequently weakened and malnourished status of the patient by the time the diagnosis is made, the difficulty of the surgery, and its proximity to many vital organs. Aggressive surgery, however, may be justified, particularly for some patients with lesions in the lower half of the esophagus.
For this procedure, both the chest and the upper abdomen have to be exposed. The esophagus lies at the very back of the chest, behind the heart and breathing tubes, both of which have to be moved out of the way or worked around.
It may be that the surgeon, after exploring the cancer site, decides that the planned procedure cannot be successful and decides against it. If he or she chooses to go ahead, the first step is to identify all tissue that needs to be and can be removed. Since this includes the esophagus, a replacement must be found.
Most often the stomach is pulled up into the chest and attached to the upper end of the esophagus, above the cancer. In some cases, a synthetic tube or a piece of small intestine is substituted for the missing piece of esophagus.
Along with the diseased portion of the esophagus, the surgeon will remove every suspicious lymph node he or she can find. Few other organs in the area can be removed, even partially, thus limiting the usefulness of surgery for widely spread disease.
Your stay in the hospital may extend over several weeks due to the extensive nature of the surgery and the high rate of severe complications. Once you are home to recover, it may take even longer before you feel comfortable.
Cure rates for this procedure are quite poor and comparable to primary treatment with
radiation. Somewhat better results are obtained for combinations of chemotherapy
and radiation or of all three modalities.
Complications of esophagectomy are many and severe. This is because the procedure is complex and risky. Also, people are often weakened by the disease before going into surgery, and are therefore more prone to complications. Possible complications include the following:
After an esophagectomy, you will be in an intensive care unit (ICU) for many days while your lungs, circulation, and digestive tract heal. You will be very closely monitored. You may receive nutrition through intravenous fluids and total parenteral nutrition (TPN). TPN is the injection of nutrients directly into a major vein, therefore bypassing your digestive tract. There are many possible complications during recovery from any surgery, particularly a major surgery such as an esophagectomy:
Most efforts to improve your comfort and prolong your useful life will be attempts to get nutrition into you when your esophagus is blocked off. In advanced stages of obstruction, you will not even be able to swallow saliva, so choking and aspiration into your lungs will be a constant threat.
can be inserted through your abdominal wall and directly into your stomach or small intestine in order to feed you when you cannot swallow. This will help prevent starvation and also help prevent aspiration of material into your lungs.
The feeding tube can be placed as part of another surgical procedure or as a separate out-patient procedure. Once the rubber tube is placed through your skin and into your stomach or small bowel, it is fixed securely, both inside and out, and plugged. The procedure itself takes little time, can be done during
or gastroscopy, and has few complications. It will add no time to your hospital stay or to your recovery from other treatments.
This procedure always accomplishes its purpose. Complete, balanced liquid meals can be delivered through the tube at any time.
Bleeding, infection, or irritation where the tube exits the abdomen are the only likely problems with feeding tubes.
Once you have a feeding tube placed, your nurse will help you care for it. This involves keeping the wound site clean, changing the dressings, and monitoring the site for any signs of infection.
There are a few methods for keeping a route open through relatively natural passages:
Each of these three methods is temporarily effective in allowing you to eat, or at least to drink, but the cancer is still growing and will eventually prevent further attempts to maintain an opening.
The main complications of these methods are the following:
Some healing time will be required after each of these procedures, during which other methods of nourishing will be used. Depending upon the type of procedure and your response to it, you will start on liquid food when your doctor thinks it is safe.
Esophageal cancer. National Cancer Institute website. Available at:
http://www.nci.nih.gov/cancerinfo/wyntk/esophagus. Accessed December 2, 2002.
Harrison's Principles of Internal Medicine.
14th ed. McGraw-Hill; 1998.
Neoplasms of the esophagus. American Cancer Society website. Available at:
http://www.cancer.org/docroot/home/index.asp. Accessed November 30, 2002.
9/18/2007 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php: Küchler T, Bestmann B, Rappat S, Henne-Bruns D, Wood-Dauphinee S. Impact of psychotherapeutic support for patients with gastrointestinal cancer undergoing surgery: 10-year survival results of a randomized trial.
J Clin Oncol.
Last reviewed September 2012 by Mohei Abouzied, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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