Minimally invasive esophagectomy (esophageal plication)

The esophagus is the tube that moves food from your throat to your stomach. When the esophagus develops cancer or high-grade dysplasia (abnormal cell growth or a risk for cancer), the multidisciplinary team at the Esophageal Center at Cedars-Sinai may recommend that the surgeon perform an esophagectomy to remove all or part of the esophagus.

If the surgeon is concerned that there may be an underlying disease not identified by testing, a staging procedure may be performed where a laparoscope (a tube with a camera) is inserted into the patient to confirm the stage of the cancer and make an informed decision on whether the patient is a good surgical candidate. Endoscopic ultrasound can also be used to stage the cancer. Sometimes the staging procedure can be performed on the same day as the surgery unless biopsies are necessary. In this situation, surgery is delayed pending the biopsy results.

Surgical Procedures

The surgeons at the Esophageal Center are experienced in both open and minimally invasive surgery for the treatment of esophageal disorders. There are four types of esophagectomy procedures, three invasive or open surgeries and one minimally invasive approach. You and your doctor will decide which option is best for you, based on your overall health, age and prognosis but all esophagectomy surgeries may take up to six or seven hours:

  • Trans-hiatal esophagectomy: Through incisions in your neck and upper abdomen, surgeons remove the part of your esophagus where the cancer or dysplasia is located. Lymph nodes are removed to see if the cancer has spread and staples are used to close off part of your stomach.  Your remaining esophagus will be reconnected to your stomach, using part of your stomach to create a new tube
  • Trans-thoracic esophagectomy: This surgery is similar to trans-hiatal surgery although the incisions are made in your right chest and upper abdomen
  • En block esophagectomy: This is the most invasive open esophageal surgery as larger incisions are made to your neck, chest and abdomen and your entire esophagus and a large portion of your stomach is removed. The remaining portion of your stomach is then shaped to resemble your esophagus. In this procedure, your surgeon typically removes all of the lymph nodes in your chest and abdomen
  • Minimally invasive esophagectomy:  This approach is similar to open surgical procedures except the incisions made to your upper abdomen, chest and lower neck are small. A laparoscope is inserted through one of the incisions and the video from this tiny camera is viewed by the surgeon as a guide during the procedure. There are distinct advantages to this procedure if it is possible, including less chance of infection and a shorter recovery time as well as a lower chance of morbidity, shorter hospital stays and a more rapid return to normal activities

All patients will have a feeding tube in place while they recuperate from the surgery.

Risk Factors and Side Effects

Your surgeon will discuss the risks of esophageal surgery with you.  Elderly patients as well as patients who are obese, young , smoke heavily, take corticosteroids or are unable to walk, are at an increased risk of complications. As with any surgical procedure, you may be at risk for blood clots, infection or stroke.

Recovering From Surgery

No matter which procedure your surgeon performs, recovery from an esophagectomy is slow, although the minimally invasive approach usually means a faster recovery. You will undoubtedly be in the intensive care unit for a few days and might be hospitalized for as long as a week.

You will probably be asked to walk the day of or day after your surgery. You will be fed through a feeding tube which may be removed a week or so after your procedure, although the timing for this depends on the patient’s progress. You will be able to resume a normal diet after some period of a clear liquid diet. Patients may find that they can’t eat as much as they did before at one sitting so smaller, more frequent meals can help with this. Recovering patients should avoid smoking, watch their weight and avoid excessive alcohol intake.  You are encouraged to move as much as you can to avoid complications from blood clots.

It is possible that you might require chemotherapy or radiation after your surgery, which is not uncommon for cancer patients. Your oncologist, along with your surgeon, will discuss these options with you.

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