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What is esophageal cancer?
In an esophagectomy, a surgical procedure to remove esophageal cancer, some or all of the swallowing tube (esophagus) is removed and then reconstructed by using part of another organ.
The esophagus is a long hollow muscular tube connecting the throat (pharynx) with the stomach. Esophageal cancer originates from any of the layers of the esophagus. It is the sixth most common cause of cancer deaths worldwide. The most common symptom of esophageal cancer is trouble swallowing, or dysphagia, which occurs when the cancer grows and the opening to the esophagus gets smaller.
What is a transhiatal esophagectomy?
The surgical treatment for removing esophageal cancer is called an esophagectomy. In an esophagectomy procedure, some or all of the swallowing tube (esophagus) is removed and then the esophagus is reconstructed by using part of another organ, usually the stomach. Esophagectomy is a common treatment for esophageal cancer that includes aggressive and nonaggressive cancers.
- If a surgeon performs an esophagectomy by making incisions in the abdomen and neck, it is called a transhiatal esophagectomy. This procedure is one of the types of open esophagectomy.
- If a surgeon performs an esophagectomy by making incisions in the abdomen and chest, it is called a transthoracic esophagectomy.
- Rarely, surgeons make an incision in the neck, chest, and abdomen if required, which is called a three-field esophagectomy.
What happens during a transhiatal esophagectomy?
Usually during a transhiatal esophagectomy patients are given general anesthesia. It is major surgery, and the procedure may last for five to six hours depending upon the patient’s condition.
- After anesthesia is given, the surgeon monitors the patient’s vitals throughout the procedure.
- The surgeon makes incisions in the abdomen and neck to deliver the instruments used for the procedure.
- The surgeon may then remove some or most of the esophagus, a portion of the top of the stomach, and nearby nodes or tissues where the cancer is involved.
- The length of the esophagus and the part of the stomach that is removed depend on the stage and location of cancer.
- Once the diseased part is removed, the surgeon reconstructs the esophagus with the stomach by pulling it up. In some circumstances, a portion of the intestine rather than the stomach may be pulled up and connected to the esophagus.
- After the surgeon completes the procedure, they suture the incisions.
- Patients may then be monitored in the intensive care unit (ICU) until they wake up.
What are the risks involved in a transhiatal esophagectomy?
There are risks associated with any surgical procedure, and these are usually explained to the patient and their family. The risks are as follows:
- Bleeding
- Infection
- Cough
- Leakage from the surgical connection of the esophagus and stomach
- Changes in voice
- Acid or bile reflux
- Nausea, vomiting or diarrhea
- Respiratory complications, such as pneumonia
- Dysphagia (swallowing difficulties)
- Atrial fibrillation
- Death
How does a transhiatal esophagectomy affect digestion and absorption?
After the procedure, the doctor will recommend tube feeding (enteral nutrition) through a small tube placed through the abdomen that connects to the small bowel. This type of feeding will continue for four to six weeks to ensure adequate nutrition while the patient recovers.
Once the patient recovers and starts a normal diet, they may need to eat frequently in smaller quantities because the stomach size is reduced. However, the patient may have nutrient deficiency, and the doctor may prescribe vitamins and supplements.
Absorption and digestion processes may change due to stomach size. The patient might feel more hunger, and they may need to eat frequently over the day.
The patient may also lose weight because the stomach size was reduced; hence, the patient must consume frequent small portions regularly after a transhiatal esophagectomy.
After the surgery, the remaining esophagus may not be able to move foods as easily from the patient’s mouth to their stomach.
Certain foods can block the esophagus or be difficult to swallow. Some people may complain of food "sticking" or have mid-sternal (behind the breastbone) pain. This may be prevented or resolved by sipping fluids when eating solid foods, chewing foods well, eating soft or chopped foods, and avoiding tough, gummy, or stringy foods.
What is the outcome of a transhiatal esophagectomy?
A transhiatal esophagectomy is an effective operative approach for esophageal cancers. The procedure has fewer complications and a high survival rate in a five-year case study. Sometimes, however, this procedure may also be used along with chemotherapy to increase the survival chances of the patient.