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Surgery

Esophagectomy and Esophagogastrectomy

The goal of surgery is to remove the tumor as well as a margin of cancer free tissue around the tumor. The two most common operations done to accomplish this are esophagectomy and  esophagogastrectomy. Esophagectomy is used for tumors that involve the esophagus but not the upper part of the stomach--GE junction. Most of the esophagus and nearby lymph nodes are removed and the stomach is brought up and attached to the remaining esophagus. An esophagogastrectomy involves removing the esophagus, the nearby lymph nodes and the upper part of the stomach. Tumors that involve the GE junction require removing part of the stomach as well as most of the esophagus the remaining stomach is brought up and connected to the remaining esophagus.

There are three operations used for removal of an esophageal cancer. Many factors need to be considered to determine the best operation for each individual. Your overall condition, size of your tumor, location of your tumor and involvement of tissue or organs near the tumor will help decide which operation will be performed. The commonly used approaches are minimally invasive, transhiatal, and transthoracic esophagectomy.

Minimally Invasive Esophagectomy

The term “minimally invasive” refers to the use of laparoscopic and thoracoscopic techniques. This procedure replaces long incisions in the chest and abdomen previously used for esophagectomy with multiple small incisions used for laparoscopy and thoracoscopy. Through these small incisions instruments are passed that accomplish the dissection and removal of the esophagus. The operation involves the minimally invasive techniques except for the final connection of the stomach and esophagus in the neck. This part of the operation is done with standard open techniques through a small 3-inch incision.

Transhiatal Esophagectomy

This approach uses an abdominal incision and a neck incision.  The abdominal part of the operation involves freeing the stomach and esophagus from surrounding structures and taking out lymph nodes in the area. The neck incision is made to visualize and free the upper portion of the esophagus. The esophagus is then removed and a tube is constructed out of the stomach that is then brought up and attached to the remaining portion of the esophagus in the neck. This operation accomplishes the same goals as the   minimally invasive approach.

Transthoracic and Abdominal Esophagectomy (Ivor-Lewis)

This approach involves an incision in the abdomen and a separate incision in the right chest.  The lower portion of the esophagus and the upper portion of the stomach are disconnected from their surroundings through an abdominal incision. Nearby lymph nodes are also removed.  Then a right chest incision is made and the remaining portion of the upper esophagus is removed.  The stomach and esophagus are removed. The stomach is reconfigured into a tube and pulled up and attached to the remaining portion of the esophagus.  In this surgery the stomach and esophagus are reattached in the chest.
 

Virginia Piper Cancer Institute
Abbott Northwestern Hospital
800 East 28th Street, Minneapolis, MN 55407
612-863-4633

First published: 10/17/2005
Last updated: 10/17/2005

Reviewed by: Dr. Daniel Dunn, Marge Watry