Esophagectomy is a definitive surgical procedure used to remove all or part of the esophageal tissue, primarily for the treatment of malignant tumors or severe structural abnormalities. This surgery can be performed via thoracotomy, laparotomy, or minimally invasive endoscopic approaches, commonly in patients with advanced esophageal cancer or Barrett's esophagus complicated by malignant transformation. The goals include complete removal of cancer cells, reconstruction of the digestive tract continuity, and restoration of the patient's swallowing function.
Preoperative chemotherapy or radiotherapy is often combined to reduce tumor size. Postoperative patients require long-term follow-up to monitor for recurrence or complications. In Taiwan, this treatment is usually performed by thoracic or general surgeons and requires multidisciplinary team collaboration.
1. Thoracotomy and Laparotomy Esophagectomy: Accessed via median sternotomy or lateral thoracotomy, directly removing the diseased segment of the esophagus, followed by reconstruction of the digestive tract using the stomach or intestinal segments. This approach is suitable for patients with extensive tumors.
2. Minimally Invasive / Thoracoscopic-Assisted: Using endoscopic instruments for minimally invasive resection, resulting in smaller incisions but requiring advanced skills. Robotic-assisted surgery can enhance precision but requires specialized equipment.
3. Partial Resection and Reconstruction Mechanisms: After removal, often using gastric pull-up or colonic interposition to replace the esophagus, with anastomosis of the digestive tract to the pharynx. The anastomosis must be closely monitored to prevent leaks.
Main indications include:
Locally advanced tumors unresponsive to chemotherapy/radiotherapy or lesions unresectable by endoscopic mucosal resection are also indications for surgery. Patients over 70 years old or with compromised cardiopulmonary function require individual assessment.
The surgery is divided into three stages:
The operation typically lasts 6-12 hours under general anesthesia. Fasting is required for 3-5 days postoperatively, with nasal gastric tube drainage. Once bowel function recovers, liquid diet is gradually introduced.
Main benefits include:
Compared to conservative treatments, early-stage esophageal cancer patients can see a 30-50% increase in 5-year survival rates. Minimally invasive approaches can reduce postoperative pain and hospital stay.
Common short-term complications include:
Long-term risks include:
Severe risks: Leaks may lead to mediastinitis, requiring immediate surgical intervention.
Contraindications include:
Preoperative assessments should include:
Interactions with chemotherapy include:
Use of anticoagulants should be stopped 7 days before surgery, with risk assessment for thrombosis. Immunosuppressants require dose adjustments to prevent infections.
According to Taiwan Cancer Registry data, the 5-year survival rate for early esophageal cancer patients after surgery can reach 40-60%. Multicenter studies show that minimally invasive esophagectomy reduces complication rates by approximately 30% compared to traditional open surgery.
The 2020 Cochrane review indicates that the extent of lymph node dissection correlates positively with prognosis. However, for metastatic tumors, surgical benefits are limited, and systemic therapy should be combined.
Non-surgical options include:
Disadvantages of alternatives:
Preoperative preparations include comprehensive examinations such as cardiopulmonary assessments, nutritional status analysis, and gastrointestinal imaging. Doctors may recommend dietary adjustments, such as high-protein, low-fiber foods, and swallowing training to reduce postoperative complications. Patients should stop certain medications in advance and confirm anesthesia and surgical details with the medical team.
What should be noted for long-term management of esophageal substitute tubes (e.g., gastric conduit) after surgery?Patients with reconstructed digestive tracts using stomach or intestinal segments should monitor for reflux symptoms long-term, possibly requiring ongoing acid suppression therapy. Daily diet should be small, slow-chewed, and avoid overeating. Regular endoscopic examinations are recommended to monitor healing and early detection of abnormal lesions.
How long does postoperative dysphagia usually last? How can it be alleviated?Short-term swallowing difficulties typically improve within 3-6 months, but individual variations exist. Swallowing training guided by speech therapists, dietary modifications (such as liquids or semi-solids), can help. Severe cases may require temporary nasal feeding tubes and nutritional planning by dietitians.
How long must dietary adjustments be continued after surgery? Is normal eating possible?Initially, a staged diet plan should be followed, gradually returning to normal eating over 3-6 months. Patients should avoid spicy, hot, or hard-to-chew foods and eat in small portions to reduce reflux risk. About 80% of patients adapt within one year, but lifelong attention to dietary habits is necessary.
How can the risk of pulmonary infection after surgery be reduced?Pulmonary infections are common postoperative complications. Deep breathing exercises, frequent turning, and early mobilization can reduce risk. Doctors may prescribe bronchodilators or physical therapy to improve lung capacity. Patients should avoid smoky environments and report symptoms like fever or difficulty breathing promptly for early treatment.
%201.svg)
Copyright © 2025 MedFrontiers. All Rights Reserved.
