Esophagectomy is a surgical procedure that involves the complete or partial removal of the esophagus, often used to treat advanced esophageal cancer, Barrett’s esophagus, or various noncancerous conditions. The surgery can be performed through several methods including transhiatal, transthoracic, thoracoabdominal, or minimally invasive laparoscopic techniques, with the extent of the removal varying based on specific factors. Complications can include bleeding, infections, voice changes, and swallowing difficulties, with relative contraindications being advanced age and comorbid illnesses.

1. Esophagectomy
---SoushritaPurkait
3rd proff part 1 , NRSMCH

2. Introduction
 Esophagectomy is a surgical procedure to remove
esophagus completely or partially and then reconstruct
it using part of another organ, usually the stomach.
 Esophagectomy is a common treatment for advanced
esophageal cancer and is used occasionally for Barrett’s
esophagus if aggressive precancerous cells are present.
 It may also be recommended for noncancerous
conditions when prior attempts to save the esophagus
have failed, such as with end-stage achalasia or
strictures, or after ingestion of material that damages
the lining of the esophagus.

3. Indication
 Advanced esophageal cancer
 Barrett’s esophagus if aggressive precancerous cells
are present
 End-stage achalasia or strictures,
 After ingestion of material that damages the lining of
the esophagus.

4. Procedure
There are many ways to perform an esophagectomy,
including:
• Transhiatal (through the diaphragm): Incisions (cuts)
are made in the belly and the neck. This allows the
surgeon to reach the esophagus.
• Transthoracic (through the thoracic cavity): Incisions
(cuts) are made in the belly and one side of the chest.
This allows the surgeon to reach the esophagus.
• Thoracoabdominal (through the abdominal cavity): One
large incision (cut) is made from the chest to the belly.
This allows the surgeon to reach the esophagus.
• Minimally invasive laparoscopic esophagectomy: Many
small incisions (cuts) are made, allowing for the insertion
of surgical tools and a lighted camera, which are used
during the procedure.

5. Typesof
esophagecty

6. Contd.
 The extent of the esophagectomy and how much of the
esophagus is removed depends on many factors, such
as disease size and location.
 At times, the stomach or the intestine is connected to a
piece of the esophagus that is left in place at the time
of surgery.

7. Stepsof
transhiatal
esophagectomy
Transhiatal esophagectomy is performed in five phases,
as follows [15] :
1. Abdominal phase
2. Cervical phase
3. Mediastinal dissection
4. Creation and positioning of the gastric conduit, and
abdominal closure
5. Construction of the cervical esophagogastric
anastomosis (CEGA)
During esophagectomy, lymph nodes may also be
removed to check for possible spread of cancer.

9. Complications
 Bleeding.
 Blood clots.
 Injury to the spleen and/or trachea.
 Infection.
 Pneumonia.
 Voice changes.
 Leaking at the site of internal stitches
 Leaking of a type of lymphatic fluid, called chyle.
 Trouble with swallowing because of narrowing of the
esophagus.
 Delayed gastric emptying .
 Heartburn.
 Dumping syndrome

10. Contraindication
Relative contraindication:
 Advanced age
 Comorbid illness