What Happens After an Esophagectomy?

Esophagectomy is a major procedure. You will have to heal in the hospital for two weeks, medicated and fitted with a chest drain and feeding tube, which you may need for up to six weeks.

An esophagectomy is the surgical removal part or all of the esophagus, which is the tube that carries food from the mouth to the stomach. 

The esophagus is usually replaced with the stomach, and rarely a part of the colon, so the patient is able to eat.

What is Esophagectomy Used For?

The most common reason esophagectomy is performed is to remove cancer, most commonly adenocarcinoma of the esophagus. The second most common type of esophageal cancer is squamous cell carcinoma. 

Other reasons esophagectomy is performed include: 

• Pre-cancer (Barrett's mucosa with high grade dysplasia)
• Severe scar or narrowing (such as from severe acid reflux disease)
• Loss of ability of the esophagus to transport food (such as from achalasia or injury from multiple surgeries)

There are different ways to perform esophagectomy surgery, depending on the patient’s condition. 

• Ivor Lewis esophagectomy (also called transthoracic esophagogastrectomy)
  • Incisions are made in the center of the abdomen and in the back of the chest
  • The tumor is removed
  • The stomach is reattached to the remaining part of the esophagus
• Transhiatal esophagectomy
  • Incisions are made in the neck and abdomen
  • The esophagus is removed 
  • After the tumor is removed, the stomach is attached to the remaining part of the esophagus through the neck incision
• 3-hole esophagectomy (also called McKeown esophagectomy)
  • Incisions are made in the abdomen, neck, and right upper back
• Minimally invasive esophagectomy
  • A laparoscope is inserted into the abdomen and chest through multiple small incisions in the abdomen and back, below the shoulder
  • A robot may be used to assist

After an esophagectomy, patients will be in the hospital for a few days up to 2 weeks. The length of time spent in the hospital depends on the type of procedure that was performed and how well the patient is doing. Following surgery, patients will have: 

• A chest tube to drain blood, fluid, and air from around the lung after surgery (it will be removed when fluids stop draining)
• A feeding tube for nutrition (J-tube)
  • This will remain in place until the patient is eating normally and can get adequate nutrition
  • It may take 4 to 6 weeks or more for the tube to be removed
  • After the feeding tube is removed, patients start on a clear liquid diet before progressing to other liquids and soft foods
• Pain medications

Once patients leave the hospital:

• Follow instructions from medical providers on how to clean and care for surgical incisions
• Patients are usually permitted to shower 48 hours (2 days) after the chest tube is removed
• Feeding tube will remain in place until the patient is eating normally and can get adequate nutrition
  • It may take 4 to 6 weeks or more for the tube to be removed
  • After the feeding tube is removed, patients start on a clear liquid diet before progressing to other liquids and soft foods
• A doctor will advise on whether to continue with clear liquids or to progress to soft foods
  • Patients can usually start eating soft foods such as casseroles, stew, pudding, oatmeal, most cereals, eggs, canned or cooked fruit, mashed potatoes, cooked or pureed vegetables, and yogurt about 2 weeks following surgery
  • Patients will have to be careful about foods they eat for months following surgery, and in some cases, for life
• Patients may have digestive problems
  • Constipation
  • Weight loss
  • Gas (flatulence)
  • Dumping syndrome, which occurs after eating fatty or rich foods
    • A special diet, low in carbohydrates, may be advised 
    • Usually goes away over time
    • Symptoms of dumping syndrome include: 
      • Lightheadedness
      • Upset stomach
      • Diarrhea
      • Cramps
      • Dizziness
      • Flushing
      • Sweating
      • Nausea
      • Vomiting
  • Pain medications may be needed 
  • Patients are usually advised to resume some light activity; follow your doctor’s recommendations
  • Arm and shoulder exercises are recommended as soon as the chest tube bandage is removed to help regain full arm and shoulder movement
  • Most patients can return to work or normal activities in about 6 to 12 weeks
    • For patients who need other cancer treatments such as chemotherapy, it can take 3 to 4 months to resume normal activities

Complications after esophagectomy include: 

• Surgical complications 
  • Blood loss
  • Injury to the spleen requiring removal
  • Injury to the trachea 
  • Death
• Post-operative complications
  • Leakage from the anastomosis
  • Hoarseness from vocal cord nerve injury (may be permanent) 
  • Excessive leakage of lymph fluid (chyle)
  • Wound infection
  • Pneumonia