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Esophageal Surgery

What is the Esophagus?

The esophagus is a muscular tube that carries food from =your mouth to your stomach. A variety of benign and malignant diseases may arise I the esophagus requiring surgical intervention.

What is a Zenker’s Diverticulum and how is it Treated?

High pressure in lower pharynx (neck portion of the esophagus) by the cricopharyngeus muscle causes an outpouching of the esophagus known as a Zenker’s Diverticulum. It mainly affects older adults and may be asymptomatic but if large may present as difficulty swallowing, regurgitation of food into the mouth, cough, and bad breath.  If you have any of these symptoms your physician will order a barium (contrast) swallow study, a CT scan of the neck with oral contrast, or an upper endoscopy which will provide the diagnosis.  It is treated by a small neck incision, dividing the cricopharyngeus muscle and removing the diverticulum or by endoscopic stapling.

What is Achalasia and how is it Treated?

Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) at the junction of the esophagus and stomach (GE junction).  This causes incomplete emptying of the esophagus and symptoms such as difficulty swallowing, regurgitation, and occasionally chest discomfort.  Diagnosis is reached by a barium swallow and the characterisitic  ‘birds beak’ appearance and esophageal manometry which identifies the high pressure at the LES.  For mild disease, drugs that reduce LES pressure may be helpful such as calcium channel blockers or nitrates or the Gastroenterologist may perform Botox injections of the LES or perform balloon dilation of the LES. For more advanced disease, a Heller myotomy is performed often with a partial fundoplication to prevent postoperative reflux disease. The Heller myotomy consists of cutting the muscular layers of the esophagus at the GE junction leaving the inner lining (the mucosa) intact.  If the disease is very advanced and the esophagus is extremely dilated, called a “megaesophagus”, an esophagectomy (removal of the esophagus) is often required.

What is Esophageal Cancer?

Esophageal cancer is a malignancy of the esophagus.  There are two main types, squamous cell carcinoma and adenocarcinoma. Squamous cell is often associated with smoking and alcohol consumption and adenocarcinoma is often associated with gastroesophageal reflux disease (GERD) and Barret’s esophagus.  Difficulty swallowing (dysphagia), painful swallowing (odynophagia) are the most common symptoms. Often it is hard to swallow bulky food but liquids may be tolerated. Pain behind the sternum is common as is weight loss and poor appetite.  A barium swallow is usually ordered which often shows a defect concerning for cancer but it is definitively diagnosed by an upper endoscopy (EGD) with biopsies. Once diagnosed, other testes such as endoscopic ultrasound, CT scan, and PET scan are performed to assess for local or distant metastasis (cancer spread).

How is Esophageal Cancer Treated?

Treatment is based on the stage of your cancer. The stage is determined by the size of your tumor, if your tumor has spread locally to lymph nodes or surrounding structures, or if your tumor has spread to distant organs.  Your oncologist, gastroenterologist, and your surgeon will determine your best course of treatment depending on the stage of your cancer. This typically includes surgery, with chemotherapy and radiation therapy given either before (neoadjuvant) or after (adjuvant).  Surgical treatment involves removing the esophagus, called an esophagectomy, and pulling the stomach up through the chest cavity and attached to the remaining portion of the esophagus either in the chest or the neck and placing a feeding tube into the small intestine for feeding until you have healed and are able to eat normally. You will have incisions in your abdomen and either your neck or chest depending on the approach your surgeon feels is best for you.

What Should I Expect after my Esophagectomy?

After your surgery, you will be in the hospital 7-10 days. At approximately 7 days after your surgery, a swallow study is performed to check for a leak at the anastomosis, and if no leak is present you will begin a soft diet.  A dietician will go over your diet restrictions  and you will be sent home with tube feeds through your feeding tube at night which will be set up by your home health nursing provider.  The feeding tube is typically removed at your follow up appointment with your surgeon in the clinic.  Additional treatment in the form of chemotherapy and/or radiation therapy will be determined by your team of physicians and is based on the final pathologic stage of your tumor from the operation.

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