Esophagectomy

Esophagectomy is a major surgery performed at Massachusetts General Hospital as both a minimally invasive and standard procedure to remove a diseased esophagus and create a new, healthy esophagus.

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Esophagectomy is a surgery that involves removing the esophagus, the tube that connects the mouth and stomach, and the top part of the stomach. A portion of the stomach is then pulled up into the chest and connected to the remaining, healthy portion of the esophagus or pharynx, creating a "new" esophagus. Massachusetts General Hospital is one of the few facilities in Boston offering a minimally invasive esophagectomy, in addition to the standard open esophagectomy.

Esophagectomy may be recommended for patients with the following conditions:

  • Some benign (non-cancerous) conditions of the esophagus including advanced achalasia and some revisional anti-reflux procedures
  • Barrett's esophagus
  • Esophageal cancer

Research published by the Massachusetts General Hospital Division of Thoracic Surgery  has demonstrated that patients undergoing a minimally invasive esophagectomy have fewer respiratory complications and a shorter length of stay, leading to a faster recovery. Research has further shown that results of standard and minimally invasive esophagectomies are equivalent in regards to oncologic outcomes or cancer survival.How is an Esophagectomy Performed?Virtually all patients who need an esophagectomy are candidates for the minimally invasive, or laparoscopic, procedure. The procedure is completed with small incisions rather than separating the ribs or making a large incision, as in standard surgery. Under the care of an anesthesiologist, the patient will receive general anesthesia. Surgeons performing this technically demanding surgery place tiny cameras in the patient’s abdomen and chest. Images from the cameras are transferred to a monitor and the procedure is completed using these video images.

During esophagectomy, the cancer and adjacent lymph nodes are removed and part of the stomach is then used to rebuild the esophagus. The operation, whether performed minimally invasive or open, typically takes approximately five to six hours.What Preparation is Required Before Esophagectomy?Before esophagectomy, most patients will undergo imaging procedures (CT or PET/CT) and an assessment of cardiovascular fitness. Patients will also meet with an anesthesiologist prior to the procedure.What is the Recovery Time?Patients spend one night in the intensive care unit after surgery. Most patients are then moved to an inpatient hospital room for about seven days.  

Patients should expect four to six weeks for more complete recovery and some adjustment in eating patterns after the procedure. Most patients will benefit from eating smaller, more frequent meals after esophagectomy.

Most patients can expect to eventually return to all normal activities following esophagectomy. During the recovery period, we encourage patients to walk as much as possible to regain strength and endurance.How Safe is the Procedure? There are significant risks with any large procedure. However, many studies have demonstrated that outcomes are better in hospitals, such as Mass General, that perform a high volume of procedures.

Your surgeon will outline the risks in detail prior to any surgical procedure. Esophagectomy for Barrett's EsophagusOnce Barrett's esophagus progresses to cancer, removal of the esophagus may be necessary.

Historically, surgery has been used for certain non-cancer stages of Barrett's esophagus (high-grade dysplasia) in an effort to avoid operating on more advanced cancer stages of this disease. However, in the last five years, most high-grade dysplasia patients and even early cancer patients are treated with endoscopic therapy rather than surgery.
 
The Mass General Barrett's Esophagus Treatment Center has expertise in both endoscopic forms of treatment (endoscopic mucosal resection, radiofrequency ablation, and cryotherapy) and surgical therapies (esophagectomy).  

Patients with more advanced forms of Barrett’s esophagus, high-grade dysplasia (HGD) and/or early cancer (intramucosal carcinoma) often ask which form of therapy is recommended. There are no studies comparing the effectiveness of endoscopic therapy and surgery in these patient subsets. However, studies have compared outcomes from these treatments (in a retrospective fashion). These studies have shown that at five years after treatment for HGD or early cancer, endoscopic therapy, when performed in expert centers, is as effective and safe as surgery.

The decision to proceed with endoscopic therapy or surgery involves many factors including patient age, coexisting medical conditions and patient preference. At the Mass General Barrett's Esophagus Treatment Center, patients with HGD or early cancer are often evaluated by both gastroenterologists and surgeons to help make the most informed decision for each patient.

Minimally Invasive Esophagectomy (MIE)

Minimally invasive esophagectomy (MIE) is a procedure performed by Massachusetts General Hospital surgeons using small incisions to remove a diseased esophagus and reconstruct the gastrointestinal tract. For more information, visit massgeneral.org/MIE