An esophageal resection is the surgical removal of the esophagus, nearby lymph nodes, and sometimes a portion of the stomach. The esophagus is a hollow muscular tube that passes through the chest from the mouth to the stomach—a "foodpipe" that carries food and liquids to the stomach for digestion and nutrition. Removal of the esophagus requires reconnecting the remaining part of the esophagus to the stomach to allow swallowing and the continuing passage of food. Part of the stomach or intestine may be used to make this connection. Several surgical techniques and approaches (ways to enter the body) are used, depending on how much or which part of the esophagus needs to be removed; whether or not part of the stomach will be removed; the patient's overall condition; and the surgeon's preference.
There are two basic esophageal resection surgeries. Esophagectomy is the surgical removal of the esophagus or a cancerous (malignant) portion of the esophagus and nearby lymph nodes. Esophagogastrectomy is the surgical removal of the lower esophagus and the upper part of the stomach that connects to the esophagus, performed when cancer has been found in both organs. Lymph nodes in the surrounding area are also removed.
An esophageal resection may be performed in combination with pre- and postoperative radiation and chemotherapy (chemoradiation).
An esophagectomy is most often performed to treat early-stage cancer of the esophagus before the cancer has spread (metastasized) to the stomach or other organs. Esophagectomy is also a treatment for esophageal dysplasia (Barrett's esophagus), which is a precancerous condition of the cells in the lining of the esophagus. Lymph nodes are removed to be tested for the presence of cancer cells, which helps to determine if the cancer is spreading. Esophagectomy is also recommended when irreversible damage has occurred as a result of traumatic injury to the esophagus; swallowing of caustic (celldamaging) agents; chronic inflammation; and complex motility (muscle movement) disorders that interfere with the passage of food to the stomach.
An esophagogastrectomy is performed when cancer of the esophagus has been shown to be spreading to nearby lymph nodes and to the stomach, creating new tumors. When cancer invades other tissues in this way, it is said to be metastatic. The goal of esophagogastrectomy is to relieve difficult or painful swallowing (dysphagia) in patients with advanced esophageal cancer, and to prevent or slow the spread of metastases to more distant organs such as the liver or the brain.
The candidates for esophageal resection parallel those at high risk for esophageal cancer. Esophageal cancer is found among middle-aged and older adults, with the average age at diagnosis between 55 and 60. Esophageal cancer and esophageal dysplasia occur far more often in men than in women. One type of esophageal cancer (squamous cell carcinoma) occurs more frequently in African Americans; another type (adenocarcinoma) is more common in Caucasian males. Caucasian and Hispanic men with a history of gastroesophageal reflux disease (GERD) are also at increased risk, because GERD has been shown to cause changes in the cells of the esophagus that may lead to cancer. Higher risks are also associated with smoking (45%), alcohol abuse (20%), and lung disorders (23%).
Esophageal cancer is diagnosed in about 13,000 people annually in the United States; it is responsible for approximately 1.5–5% of cancer deaths each year. Although it is not as prevalent as breast and colon cancer, its rate of occurrence is increasing. This rise is thought to be related to an increase in gastroesophageal reflux disease, or GERD.
The esophagus has a muscular opening, or sphincter, at the entrance to the stomach, which usually keeps acid from passing upward. In people with GERD, the esophageal sphincter allows partially digested food and excess stomach acid to flow back into the esophagus. This occurrence is known as regurgitation. Regurgitation continually exposes the lining of the esophagus to large amounts of acid, causing repetitive damage to the cells of the esophageal lining. The result is Barrett's esophagus, a condition in which the normal cells (squamous cells) of the esophageal lining are replaced by the glandular type of cells that normally line the stomach. Glandular cells are more resistant to acid damage but at the same time, they can more readily develop into cancer cells. Studies at New York's Memorial Sloan-Kettering Hospital have shown that only 30% of people diagnosed with Barrett's esophagus will later be diagnosed with cancer; the other 70% will not develop dysplasia, the precancerous condition. Effective medical treatment of acid reflux is thought to be a factor in the low incidence of cancer in people with Barrett's esophagus. Other types of cancer can also occur in the esophagus, including melanoma, sarcoma, and lymphoma.
The risk factors for esophageal cancer include:
Cancer of the esophagus begins in the inner layers of the tissue that lines the passageway and grows outward. Cancer of the top layer of the esophageal lining is called squamous cell carcinoma; it can occur anywhere along the esophagus, but appears most often in the middle and upper portions. It can spread extensively within the esophagus, requiring the surgical removal of large parts of the esophagus. Adenocarcinoma is the type of cancer that develops in the lower end of the esophagus near the stomach. Both types of cancer may develop in people with Barrett's esophagus. Prior to 1985, squamous cell carcinoma was the most common type of esophageal cancer, but adenocarcinoma of the esophagus and the upper part of the stomach is increasing more rapidly than any other type of cancer in the United States. Up to 83% of patients undergoing esophagectomy have been shown to have adenocarcinoma. This development may be related to such changes in risk factors as decreased smoking and alcohol use as well as increased reflux disease. People at high risk for esophageal cancer should be examined and tested regularly for changes in cell types.
Esophageal cancer is classified in six stages determined by laboratory examination of tissue cells from the esophagus, nearby lymph nodes, and stomach. The six stages are:
Unfortunately, the symptoms of esophageal cancer usually don't appear until the disease has progressed beyond the early stages and is already metastatic. Without early diagnostic screening, patients may wait to consult a doctor only when there is little opportunity for cure. The symptoms of esophageal cancer may include difficulty swallowing or painful swallowing; unexplained weight loss; hiccups; pressure or burning in the chest; hoarseness; lung disorders; or pneumonia.
The decision to perform an esophageal resection will be made when staging tests have confirmed the presence of cancer and its stage. Two-thirds of people who undergo endoscopy, a close examination of the inside lining of the esophagus, and biopsies (testing esophageal tissue cells) will already have cancer, which can progress rapidly. Some will be treated with surgery and others with medical therapy, depending on the stage of the cancer, the patient's general health status, and the degree of risk. Removing the esophagus or the affected portion is the most common treatment for esophageal cancer; it can cure the disease if the cancer is in the early stages and the patient is healthy enough to undergo the stressful surgery. Esophagectomy will be recommended if early-stage cancer or a precancerous condition has been confirmed through extensive diagnostic testing and staging. Esophagectomy is not an option if the cancer has already spread to the stomach. In this case an esophagogastrectomy will usually be performed to remove the cancerous part of the esophagus and the upper part of the stomach.
An esophagectomy takes about 6 hours to perform. The patient will be given general anesthesia, keeping him or her unconscious and free of pain during surgery. One of several approaches or incisional strategies will be used, chosen by the surgeon to gain adequate access to the upper abdomen and remove the esophagus or the tumor and the nearby lymph nodes. The four common incisional approaches are: transthoracic, which involves a chest incision; Ivor-Lewis, a side entry through the fifth rib; three-hole esophagectomy, which uses small incisions in the chest and abdomen to accommodate the use of instruments; and transhiatal, which involves a mid-abdominal incision. The approach chosen depends on the extent of the cancer, the location of the tumor or obstruction, and the overall condition of the patient.
In a minimum-access laparoscopic and thorascopic procedure, the surgeon makes several small incisions on the chest and abdomen through which he or she can insert thin telescopic instruments with light sources. The abdomen will be inflated with gas to enlarge the abdominal cavity and give the surgeon a better view of the procedure. First, the camera-tipped laparoscope will be inserted through one small incision, allowing images of the organs in the abdominal area to be displayed on a video monitor in the operating room . If the surgeon is going to use a portion of the stomach to replace the resected esophagus, he or she will first locate the fundus, or upper portion of the stomach. The fundus will be manipulated, stapled off, and removed laparoscopically, to be sutured in place (gastroplasty) as a replacement esophagus.
Next, the surgeon will pass thorascopic instruments into the chest through another incision. The esophagus or cancerous portion of the esophagus will be visualized, manipulated, cut and removed. Lymph nodes in the area will also be removed. Then the surgeon will either pull up a portion of the stomach and connect it to the remaining portion of the esophagus (anastomosis), or use a piece of the stomach or intestine, usually the colon, to reconstruct the esophagus. Either procedure will allow the patient to swallow and pass food and liquid to the stomach after recovery. As discussed above, other approaches may be used to gain access to the affected portion of the esophagus.
There are several variations of an esophagectomy, including:
An esophagogastrectomy is also major surgery performed with the patient under general anesthesia. The surgeon will choose the incisional approach that allows the best possible access for resecting the lower portion of the esophagus and the upper portion of the stomach. The surgeon's decision will depend on the extent of the cancer, the amount of the esophagus that must be removed, and the patient's overall health status. An esophagogastrectomy can be performed as an open procedure through large incisions, or as a laparoscopic procedure through small incisions.
In a minimum-access laparoscopic procedure, several small incisions are made in the patient's abdomen. A laparoscope will be inserted through one small incision, allowing images of the abdominal organs to be displayed on a video monitor. As in an esophagectomy, gas may be used to inflate the abdominal cavity for better viewing and space for the surgeon to maneuver. The cancerous upper portion of the stomach will first be stapled off and resected. The cancerous portion of the esophagus will then be cut and removed along with nearby lymph nodes. Finally, a portion of the stomach will be pulled upward and connected to the remaining portion of the esophagus (anastomosis); or, if most of the esophagus has been removed, a piece of the colon will be used to construct a new esophagus. Sometimes the surgeon must make an incision in the neck in order to gain access to and resect the upper portion of the esophagus, followed by making an anastomosis between the esophagus and a portion of the stomach.
The diagnosis of esophageal cancer begins with a careful history and a review of symptoms, and involves a number of different diagnostic examinations. An esophagoscopy may be performed in the doctor's office, allowing the doctor to examine the inside of the esophagus with a lighted telescopic tube (esophagoscope). A barium swallow is another common screening test, performed in the radiology (x ray) department of the hospital or in a private radiology office. In a barium swallow, the patient drinks a small amount of radiopaque (visible on xray) barium that will highlight any raised areas on the wall of the esophagus when chest x-rays are taken. The xray studies will reveal irregular patches that may be early cancer or larger irregular areas that may narrow the esophagus and could represent a more advanced stage of cancer. If either of these conditions is present, the doctors will want to confirm the diagnosis of esophageal cancer; determine how far it has invaded the walls of the esophagus; and whether it has spread to nearby lymph nodes or organs. This staging process is essential in order to determine the best treatment for the patient.
One staging technique is a diagnostic procedure called endoscopic ultrasound. The doctor will thread an endoscope, which is a tiny lighted tube with a small ultrasound probe at its tip, into the patient's mouth and down into the esophagus. This procedure allows the inside of the esophagus to be viewed on a monitor to show how far a tumor has invaded the walls of the esophagus. At the same time, the doctor can perform biopsies of esophageal tissue by cutting and removing small pieces for microscopic examination of the cells for cancer staging. Staging tests may also include computed tomography ( CT scans ); thorascopic and laparoscopic examinations of the chest and abdomen; and positron emission tomography (PET) .
The patient will be admitted to the hospital on the day of the operation or the day before, and will be taken to a pre-operative nursing unit. The surgeon and anesthesiologist will visit the patient to describe the resection procedure and answer any questions that the patient may have. The standard preoperative blood and urine tests will be performed. Intravenous lines (IV) will be inserted in the patient's vein for the administration of fluids and pain medications during and after the surgery. Sedatives may be given before the patient is taken to the operating room.
Immediately after surgery the patient will be taken to a recovery area where the pulse, body temperature, and heart, lung, and kidney function will be monitored. Several hours later, the patient will be transferred to a concentrated care area. Surgical wound dressings will be kept clean and dry. Pain medication will be given as needed. A chest tube inserted during surgery will be checked for drainage and removed when the drainage stops. A nasogastric (nose to stomach) tube, also placed during surgery, will be used to drain stomach secretions. Nurses will check it regularly and rinse it out. It will eventually be removed by the surgeon. Until the patient is able to swallow soft foods, he or she will be fed intravenously or through a feeding tube that was placed in the small intestine during surgery. Patients will be encouraged to cough and to breathe deeply after surgery to fully expand the lungs and help prevent infection and collapse of the lungs. Walking and movement will also be encouraged to promote a quicker recovery.
About 10–14 days after the surgery, the patient will be given another barium swallow so that the doctor can examine the esophagus for any areas of leaking fluid. If none are seen, the nasogastric tube can be removed. The patient can then begin to sip clear liquids, followed gradually by small amounts of soft foods. Patients being treated for esophageal cancer may begin chemotherapy (cytotoxic or cell-killing medications), radiation therapy, or both, before or soon after discharge from the hospital . Patients typically remain in the hospital as long as two weeks after surgery if no complications have occurred.
When the patient goes home, any remaining bandages must be kept clean and dry. Frequent walking and gentle exercise are encouraged. Because laparoscopic and thorascopic surgery is less invasive and uses only small incisions, there is less trauma to the body, and activity can be resumed more quickly than with open procedures that require larger incisions. The patient should report any fever or chills, persistent pain, or incision drainage to the surgeon. The patient's diet will typically be restricted for a while to soft foods and small portions; a normal diet can be resumed in about a month, but with smaller quantities. Patients are advised not to drive if they are still taking prescribed narcotic pain medications. Daily care and assistance at home is recommended during the recuperation period. Regular medical care and periodic diagnostic testing, such as endoscopic ultrasound, is essential to monitor the condition of the esophagus and to detect recurrence of the cancer or the development of new tumors.
One of the primary risks associated with esophageal resection surgeries is leakage at the site of the anastomosis, where a new feeding tube was sutured (stitched) to the remaining esophagus. As many as 9% of all patients have been reported to develop leaks, most occurring when a portion of the stomach rather than the colon was used to construct the new section of the esophagus.
Other risks include:
Esophageal resection, especially esophagectomy, can be curative if cancer has not spread beyond the esophagus. About 75% of patients undergoing esophagectomy will be found to have metastatic disease that has already spread to other organs. Esophagectomy will reduce symptoms in most patients, especially swallowing difficulties, which will improve the patient's nutritional status as well. Patients whose esophagectomy is preceded and followed by a combination of chemotherapy and radiation treatments have longer periods of survival.
The typical result of an esophagogastrectomy is palliation, which is the relief of symptoms without a cure. Because esophagogastrecomy is always performed when metastases have already been found elsewhere in the body, the procedure may relieve pain and difficulty in swallowing, and may delay the spread of the cancer to the liver and brain. Cure of the disease, however, is not an expectation.
Patients having less invasive laparoscopic and thorascopic resection procedures will experience less pain and fewer complications than patients undergoing open procedures.
Because 75% of all esophagectomy patients and 100% of all esophagogastrectomy patients will have metastatic disease, morbidity and mortality rates for these procedures are high. Thirty-day mortality for esophagectomy ranges from 6–12%; it is 10% or higher for esophagogastrectomy. Survival of early-stage cancer patients after esophagectomy ranges from 17 to 34 months if surgery alone is the treatment. The mortality rate for early-stage cancer patients having esophagectomy alone is higher than when surgery is combined with pre- and post-operative chemoradiation. The three-year survival rate for early-stage cancer patients who received pre- and post-esophagectomy chemoradiation is about 63%. Better staging techniques, more careful selection of patients, and improved surgical techniques are also believed to be responsible for the increase in postoperative survival rates. Recurrence of cancer in esophagectomy patients has been shown to be about 43%. A higher percentage of patients undergoing esophageal resections survive beyond the 30-day postoperative period in hospitals where the surgeons perform these procedures on a regular basis.
People with Barrett's esophagus can be treated with medicine and dietary changes to reduce acid reflux disease. These nonsurgical approaches are effective in relieving heartburn, calming inflamed tissues, and preventing further cell changes.
Fundoplication, or anti-reflux surgery, can strengthen the barrier to acid regurgitation when the lower esophageal sphincter does not work properly, curing GERD and reducing the exposure of the esophagus to excessive amounts of acid.
Photodynamic therapy (PDT) is the injection of a cytotoxic (cell killing) drug in conjunction with laser treatments, delivering benefits comparable to more established treatments. Endoscopic laser treatments that deliver short, powerful laser beams to the tumor through an endoscope can improve swallowing difficulties; however, multiple treatments are required and the benefits are neither long-lasting nor shown to prevent cancer.
American Cancer Society. The American Cancer Society's Complementary and Alternative Cancer Methods Handbook . Atlanta, GA: American Cancer Society, 2002.
Harpham, Wendy S., MD. Diagnosis Cancer: Your Guide Through the First Few Months . New York: W. W. Norton, Inc., 1998.
Heitmiller, R. F., et al. "Esophagus," in Martin D. Abeloff, ed., Clinical Oncology , 2nd ed. New York: Churchill Livingstone, 2000.
American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800)ACS-2345. http://www.cancer.org .
American Gastroenterological Association. 4930 Del Ray Avenue, Bethesda, MD 20814. (301) 654-2055. http://www.gastro.org .
Ferguson, Mark, MD. Esophageal Cancer . Society of Thoracic Surgeons. http://www.sts.org/doc4121 .
National Cancer Institute (NCI). General Information About Esophageal Cancer . Bethesda, MD: NCI, 2003.
L. Lee Culvert
Esophageal resection surgeries are performed in a hospital or medical center operating room by a general surgeon or a thoracic surgeon.
I had my sugery on 7/29/09 and the g.i.s.t was removed from my stomach. The miracle is that the esophagus was not touched as the g.i.s.t was much bigger than was anticipated and it came out all in one piece. The upper part of my stomach was taken out (making the surgery a partial gastrectomy). I have lost 30 lbs in 4 weeks and I am unable to each more than a 1/4 sandwich at a time. Meat, candy, soda, chips actually junk is a turn off. I can't even think of eating it. I am greatful. I am still tired, my incision is leaking serosangunous fluid but this too shall pass. I am not ready to return to work as Ineed more time to heal. I hope my experience helps all. God and prayer works. bigtime.
I had the bottom 1/3 of my esophagus removed along with a non-cancerous tumor a year and a half ago and am still having major complications. I now have incredible pain at the surgery site and the upper part of my esophagus and I have incredible bouts of throwing up for days. If anyone has had this type of surgery can you please contact me at:
thatguyjedi@hotmail.com
I would love to discuss my issues with someone who understands and who has gone through this. Thank you.
-Paul
Rich
Please put {Esophageal cancer} in subject box
My husband was diagnosed with Stomach Cancer (top of the stomach growing into the lower portion of the esophagus). He underwent surgery on Aug. 4th, removing 20% of his lower esophagus-removing the plug "spinter" and removing 20% of his upper portion of his stomach). He was doing quite well at the hospital, was released on Aug. 13th, since returning home, he has not been able to drink...whenever he takes sips, by the 3rd or 4th sip, he'll start gagging and then will regurgitate some saliva/liquid out along with whatever he's drank. He can eat, but if he drinks, then it'll bring back up whatever he's eaten say 2 hours ago. So, on Aug. 29th, he was admitted back to the hospital due to dehydration...since admitted, they did 2 swallow test to see what's happening...and said that everything looks fine anatomically and they also did an endoscopy to dilate the esophagus just incase that's the reason...but, he's been home since Sept. 2nd, and still can't keep liquid down...
HELP!!! Any suggestions, what did you go through...did it somehow resolve itself?
I'm thinking that he should ask for some Nexium?
Thanks for reading and all your help!!!
I had a 7 inch tumor on the bottom of my esophagus that was found in Jan 2011.I went through chemo and radiation(this process srunk my tumor down to 3 inches) in march and april and then I had surgery to remove most of my esophagus and part of my stomach.I asparated a tray of food in the hospital and they had to take a liter of fluild out of my lung.The phemomia I got was terrible and ever sence I went from 230 to 167 and in the last 8 months lost most of the muscle it had taken me 58 years to build up.Right now I can take the O2 off in the day but not at night and belive soon i wont have to have O2 at all.My doctor told me to stay away from eating most ruffages(salads and other vegtibles) I did but the throwing up would not stop One day I decided to eat some celery with peanut butter and this helped hold the bile down and since have found any kind of ruffage helps keep it down. I have good days and bad days but I guess that is to be expected. i wish I could of found some reading material that could of helped me through this nightmare but I found very limited resources. The doctors just say everyone is different so they stay out of trouble.The best help to keep food and liquids down have been 2 drugs they give me Dexliant a ant-acid and reglan a drug that helps food go through your digestion systom.My prayers are with all going through this nightmare and all those helping them go through it.Without support I would not have made it. So I hope this info may help and God bless!!
with the feeding tube etc. A home health aid is also an option, any thoughts or suggestions
would be appreciated. Also, what are the restrictions in the type and or quantities of food I'll be able to eat?
contact me at; chelton50@gmail.com
and happy happy to be alive.
Advice to all- stick with it you can beat it if you try.
I am running out of options and my husband is giving up... He does not want to eat and he is very depressed.
2013 which went very well and I had a wonderful team of doctors and surgeons who are very pleased with my progress.
I am a 70 year old male. All was going very well and I am now eating almost normal food but little and often, but I
still have to wash it down with lots of water. The problem is that I seem to have a lot of mucus, it feel like a hard ball
in my throat just as I am about to swallow [not near to the join] and it prevents me from swallowing
anything. I try and have soup and the same thing happens. The surgeon and oncologist didn't seem to be too worried
about this except to say it is a slow recovery and these things can happen. But it has got to the stage that
sometimes I just can't eat or drink anything. I certainly have to cough up the mucus before I can attempt to eat any more, usually it gets better later but at the moment it is very bad.
I was told that there was still some active tumor on a few lymph nodes around the stomach but they were confident that all
had been removed, my tumour was in the lower part of the oesophagus so part of the top part of my stomach was removed and
pulled up behind the rib cage. The surgeon who did this op is one of only a few who perform the Ivor-Lewis in the UK. and
very experienced. Is this just all part of the recovery and it is 2 steps forward and 1 back and sometimes 2 steps back and 1 forward!? Can anyone give me any advice. I am not on any medication, only Omeprazole to help the acid reflux. Many thanks.
Still not fully recovered, 4-6 hour work days but GRADUALLY improving. Little information as to what to expect or anticipate following surgery, but complications since: Several dilitations (stretching of the surgical junction) to allow food to pass. Constantly spitting up white frothy liquid for the first 3-4 months, but eventually subsided. Mucuos "lump" at the junction for 6 months, largely subsided but I still get it maybe monthly. Incisional hernia, repaired in July 2012. Still have acid reflux (burning in the throat, coughing), treating with omeprazole and carafate; largely controlled but still an issue. I sleep on a "wedge" which lifts my head/throat above my stomach but if I slide down while sleeping (1-2 times per month) the bile will escape my stomach and I'm up for a couple of hours dealing with that pain (Maalox helps.) Eating has steadily improved, up from a few bites after surgery, I can now eat about 1/2 of a regular meal each sitting, weight now stabilized at 140 lbs. Soft and moist foods are preferred because of the ease of eating, but chewing thoroughly allows consumption virtually everything. Hydration is a challenge because of capacity, kidney stone in 10/12 and kidney doc anticipates I'll have more. Still have digestive issues (weakness, discomfort) following each meal, regardless of quantity or type of food. Still have numbness and pain at the surgical sites (throat, abdomen, ribcage.)
My mom had her esophagus removed in 2009 and has not had to many issues since the surgery. She still has acid reflex and also like most stories I have read sleeps sitting up but this is no different than before the surgery. A plus side she has less acid attracts than she had before surgery. I am reaching out because her biggest side affect is keeping her blood sugar up it is not uncommon for her to drop into the 40's at least once a day and she has been as low as 35. No one seems to have any answers for her so I am hoping there is someone that might be able to help.
im 60 y.o male i had this surgery done in 2011 and im telling u its easy surgery i mean the recovery from it its been 2 years since i had it done n ill still cant eat right or anything i want to eat as normal people i still having food backing up my esophagus n burn my throat n burn me like hell or sometimes shock n i cant breath getting up in the middle of the night. not to mention the pain n discomfort, and not able to sleep laying down i sleep in a sitting position so the food wont back up to my esophagus or my throat n its very tiring , n ill tell u the side effect of it too mostly u will have dumping syndrome n bad heart burn n you will lose ur spincter valve .i took lots of anti acid meds none helped me.
Try to sick to a good diet soft food dont smoke or drink alcohol , best thing for ur acid reflux n it will work right away is make a lemonade the put small amount of baking soda in it n wait till it bubbles the drink it.it will work right away , i tried it n it works.
and listen to ur rhuematoid n get a second opinion.
my advice to u dont have it done coz ill make u get worse try a good soft diet
Staging suggested I was at stage 3, with one lymph node impacted. This was enough for my doc to OK an esophagectomy. Ahead of this he got me onto nine weeks of chemo, which went surprisingly well - not so much from a curative perspective...it just didn't knock me about as bad as i'd expected.
The op took place on January 21, so today i'm one day shy of four weeks post-op.
I know that's nothing compared to many of you survivors, but after some of the tough prognoses i've read here recently, I just wanted to let anyone approaching their own op (with understandable trepidation) to know, if i'm anything to go by, its not all doom and gloom.
I've been eating solids now for almost two weeks. I'm doing the "eat a little, eat it often" approach but i'm already finding my portion sizes and opportunities to eat are increasing.
Take today...I started with aa glass of freshly squeezed juice (mango, apple, banana, carrot, beetroot and ginger) at 5.00 (i'm an early riser) ahead of a 30 minute walk. At 6.30 I had what i'd call a half serve of home-made cream of chicken soup. At 9.00 I had a half serve of german sausage and baked beans ahead of a session hitting golf balls (i'm a golf tragic and i've been told its ok for me to ease back in).
Come 11.30 it was a half serve of a lasagne I made yesterday...plenty of chewing but it went down a treat. This afternoon, after my siesta, I had a small bowl of icecream and some crackers with cheese. I'll end the day eating at about six, with a bowl of greek yogurt and mashed banana - my "baby food" indulgence.
So eating has gone well. I'm even managing a glass of white wine mid-afternoon as a treat. I've found the only problem my stomach causes is if I eat too much, too late in the day, so i'm making sure I avoid testing this out too much. If I do, its primarily stomach cramps that get me - though usually for no longer than an hour.
I've been lucky with dumping - i've had it once, and that was triggered by a necessary sugar hit (cocolate and flavoured milk) when my blood sugars dived one evening (i'm a 55 year old male insulin-dependent diabetic). Reflux has also been a rare visitor, thank heavens. Its woken me up once at night - coughing up bile is never any fun, but a glass of milk and a strong mint did the trick.
So there you have it...a month out, still no way near through recuperation, but life already feels like its establishing a new, reasonably acceptable, normal.
Hope that helps any of you approaching the op - I can't guarantee this will be what you experience, but I can tell you that it might.
I had my esophagus removed on the 4 Sept 2014. (Donald Gordon Hospital. Johannesburg).I presented with suspect cancer of the esophagus. (I was diagnosed FEb 2014 and had intense 6 months chemo to shrink the tumors).
MY surgery lasted 10 hours I was in I.C.U. (Intensive care) for 24 hours.My main discomfort was the two 15mm tubes draining my right lung and the tubes down my throat.The pain was huge but with each physiotherapy session and constant movement I felt exhausted and encourage that I would improve. The removal of the lung drains and tubes down my throat were so relieving. The pain was intense but manageable with regular intervals of medication. I tried to walk as much as possible once the drains and every second clamp from surgical wound were out. My trip to the X-ray department to check my swallowing results was so humbling and joyful. I spent 10 days in hospital. I am currently at home recovering. The discomfort and internal pain is a reminder of my good fortune. I am cancer free.
I have been fully reintroduced to food I started of with stage 2 - clear fluids. Stage 3 - Mixed fluids. Stage 4 - Purée Diet. Stage 5 - Soft Diet. I am now enjoying a carefully planned soft diet. Good luck to you if you are following in my footsteps...go for it and no pain no gain.
Just read Theresa post. Jackie (my wife) here on the Gold Coast in Australia has had her esophagus removed in June 2014. Very similar progress as Theresa. We are now almost 4 months down the line and Jackie is swimming daily (1km when she can)and playing tennis.She has had her throat dilated on 2 occasions. The biggest problem since the dilation is re-flux. We are playing with Nexium 20mg up to 40mg. 40mg caused nausea,so reverted back to 20 mg. Jackie never feels hungry so we have to constantly change diet trying to find foods that reduce reflux. We took a sea cruise for the food variety and always being available, I suggest this as a great get away and use the experience to test foods to suite you. As reflux seems to be a common problem, we should get together and solve this ourselves as there is nobody else who can. If anyone has any suggestions please let us know.
Jackie still gets some reflux, and coughing bouts. She can eat most things in small quantities as often as she can and has regained weight. We used Sustegen (Nestle) mixed with bananas or Mangoes on a daily basis and took it with us whenever we left home to ensure she fed herself about every 2 hours. We have moved on from this and she is eating well on a day to day basis without the need for the Sustigen supplement. We start the day with a cup of coffee plus a couple of biscuits then have breakfast, this gets you off to a good start of the day,mid morning snack, lunch, afternoon snack, dinner, ice cream then popcorn. We used to count calories, but now we don't bother, as her weight is quite steady. Hope this helps.
She still has the reflux, bed chocked up at one end by 150mm, high pillows and on 20mg nexium every night. However she has and still swims about a kilometer a day and is playing tennis (breathing getting a lot better). She has lost a lot of strength in her voice due to radiation but will see a speech therapist. She has problems, but it does get better and you and your body just get used to the new normal. We know this may not be the end of the battle but it might be. Was it all worth it..It is tough..There are no guarantees... YES IT IS WORTH IT.
I choose . Sleeping is the hardest thing , I have hard time sitting up to sleep.if I end up on my side I wake with mid September ton pain,other wise it's just a life style change... MD Anderson in Houston has been the Best...
I lost 40lbs and am now 140lbs, I hate the way I look and what ever I do to gain weight it will not increase.
I used to take smoothies with 1000 kal but no weight gain, they gave me drinks to improve my weight and again no gain.
I get frustrated but plod on regardless, I am alive but for how long I don't know, I used to look on net at this terrible disease and it frightened me to death hearing about survival rates, it's the worst thing you can do and much of it is outdated now.It seems to me there are no two cases alike many sypmtoms are similar to what I have,and there seems to be no advice from Doctors all they say is it will be better eventually, When I went into hospital for my operation all went well, I was told by my surgeon he had eradicated my tumor there was no bleeding whilst having the op, and it was good result all round. After surgery the fisrt day was ok but I was still under sedaition a little, the second day was my first feeling of pain. I felt great pain in my abdomen and believe me I had never felt pain like this before in my entire life.
I shouted out in agony, the next day I was okay,thank God for morphine.
I came home after 10 days which was a surprise to me, but they said that now I was eating solids there was nothing more they could do for me in hospital.I can't tell you the amount of tablets per day I was taking it was enormouse.
Well the main symptoms I have now are weakness in my legs, neurothopy in my feet which is annoying but not painful, doctors told me it was the chemotherapy to blame, and I may have this numbness in my feet for years or for the rest of my life.
I am 70 yrs old now done my three score and ten, who knows what the future is? but don't what ever you do look at the survival rates after this terrible disease it will drive you insane, hope this has been some help for others who are about to embark on this operation
I am a 56 year old women diagnosed with Esophagus cancer 16/1/2015 after having difficulty swallowing & constant re flux. I did 6 weeks of Chemoradiation, then had a Telescopic Eosphagectomy on the 12/5/2005. The operation was the hardest thing I've ever been through & I was in two minds about having it done, due to feeling better after the Chemoradiation. The 2 things that helped me deiced to go through with it were having a 9 year old son & husband who are my life & an amazing Surgeon who has a great success rate with this type of surgery! It has been 6 weeks now I had 10 days in hospital no complications, they found out it was stage 3B caner because it had reached 3 of my lymph nodes , which didn't show up on my PETScan. This makes me feel that I have defiantly done the right thing by having my Esophagus removed replacing it with part of my stomach because the cancer that was there has now all been removed. The next stage now is to get as fit & healthy as I can so that I can now have some more Chemo just incase any cancer cells have gone through my lymph nods. I just want to do everything I can to give myself the best possible chance! I had Squamous Cell Carcinoma 6cm in the mid Esophagus. I am of a small build weight 42 to 44 kg, 5ft 3'' tall, always took vitamins, ate healthy loved vegetables, chicken & fish, reasonably fit & haven't drank Alcohol for 27 years. Sometimes It's just the luck of the draw, I also have 2 sisters of 4 females in our family who have the Beca 1 gene. I always had regular check ups for breast & ovarian cancer along with bowel, I was totally unaware of Esophagus Cancer! At the moment I'm learning how to eat again , what & how much food I can tolerate, I don't feel hungry at all yet, & keeping a close eye on my weight as I can't afford to lose much.I hope this is of some help to anyone looking at which options to take in there path to recovery! I wish the very best outcomes to all, a fast & successful recovery, be Brave, Strong & Positive. Take comfort in knowing your not alone there many of us who have been through, are going through or are about to go through the very same thing! God Bless!
My 45 year old husband has esophageal adenocarcinoma. We discovered it during an endoscopy to identify why it hurt to swallow. We expected a hiatal hernia but found cancer instead. The Doctor was shocked and we were too. He has completed 5 wks radiation and chemotherapy. We are in 2nd week after. They say the chemo and radiation are still working after you finish and you feel awful. He did so well during the treatments, nausea and fatigue but no vomiting. Well they were right he felt awful the 1 week. After a trip to hospital to get IV fluids twice in one week, he is finally not as miserable. There isn't much he can eat, and he barely eats. He has to get strong for surgery or it gets scheduled later. The surgery will remove 2 thirds of the esophagus and top of stomach then join them. Sleep at 30 degree angle. Tube feeding 6 weeks after surgery. Once healed eating 2-3 hrs before bed. This is what we have been told by surgeon. I am trying to get an idea of what our life after will be like.
He grew up in Michigan during the contamination of livestock with PBBs, maybe a variable?
Thanks for your wisdom... Melissa
I then left the hospital and went to a rehab center for about two weeks before I got to go home. Almost 4 months had past since my surgery and having a feeding tube only for nourishment, but I finally got to go back and have the surgery to re-hook everything back up so I eat and drink again. Everything was a success and I got to go home within a week.
My oncologist watches me close with ct scans and blood work every few months and so far I have stayed cancer free. I do have some clearing of the throat issues and also have had pneumonia but all have been treatable. I have problems sleeping upright at night. I start out that way but wake up flat sometimes and have to sit back up. I can't control what I do in my sleep even when I use a wedge. I lost a total of about 50lbs which includes 15 of which I lost when my 2nd wife left after a year of the onset. I understood that it was hard for her to deal with my condition and she also had some family issues which were expected I thought with everyone being stressed. It has been hard to gain much weight back although I can eat pretty much what I want now. Part of the reason is living alone I'm sure. I stay between 100 - 110 lbs but I'm now working with a nutritionist in hopes of turning that around. I was never a big guy even before, about 157lbs before I got sick.
My suggestion to everyone that knows somebody with repeated long term GERD is to get in and get scoped. My family doctor tried to get me to have that done several times and I refused because I told him as long as a pill was working I didn't want to do it out of fear of the procedure.
I'm consider myself to be very lucky and I'm thankful for the doctors,nurses, family and friends that I had and still have helping me through! I hope this gives some encouragement to those of you fighting this type of illness. I had so many complications that nobody was planning on yet still I'm here alive and well.
Walt