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Esophagogastrectomy

Great Surgical Care at Marina del Rey Hospital



Why Choose Cedars-Sinai Marina del Rey Hospital for Your Esophagogastrectomy?

At Cedar-Sinai Marina del Rey Hospital, we offer you the best services due to our skilled and experienced healthcare providers. Our specialists have a long history in the management of patients with esophageal diseases. Thoracic and general surgeons will work together with the multidisciplinary team of radiation oncologists, medical oncologists, and gastroenterologists to ensure the success of meeting your health needs.

Esophagogastrectomy is a procedure most often performed in cases of esophageal cancer, in the stage when cancer has spread to the stomach. It is also a treatment method for esophageal dysplasia (Barrett’s esophagus).

The surgical procedure is complex and implies high risks and complications because the patient will have his/her esophagus and upper section of the stomach removed. Some lymph nodes from the vicinity of the esophagus can be removed as well, and they can be tested to determine how far the presence of the malignant cells has spread.

Healthcare providers can recommend esophagogastrectomy in cases of patients who have suffered irreversible damage to the esophagus due to traumatic events (swallowing caustic agents, chronic inflammation, disorders that interfere with the passage of food through the esophagus).

Before esophagogastrectomy, the healthcare provider will examine the patient to determine if he/she is a good candidate for this type of surgery. Several tests can be performed to evaluate the cardiovascular, pulmonary, renal, neurologic, and endocrine system functioning and health state. Dysfunctions in these body systems can lead to complications for patients undergoing the procedure.

Esophagogastrectomy is performed on the patient under general anesthesia. The surgeon decides on the incisional approach best suited for access to the lower part of the esophagus and the upper part of the stomach. For this decision, the following aspects are taken into consideration:

  • the extent of the cancer
  • how much of the esophagus and the stomach must be removed
  • the overall health status of the patient

The procedure can be performed:

  • as an open procedure – this requires a large incision
  • or through laparoscopy – which requires small incisions

In the case of a laparoscopic procedure, the surgeon will make small incisions into the abdomen of the patient. The laparoscope is used to display images of the inside of the abdomen by inserting it in one of the incisions. For better viewing, gas can be used to inflate the abdominal cavity. This also provides more space for the maneuvering of the surgical tools.

First, the upper part of the stomach that is cancerous is stapled off and resected. Then, the cancerous part of the esophagus is removed, along with the lymph nodes from the nearby area. The remaining portion of the esophagus needs to be reconnected to the remaining portion of the stomach. To do this, the surgeon will pull upward a portion of the stomach. 

If most of the esophagus was affected by cancer and its removal was necessary, the surgeon can use a part of the colon to reconstruct the esophagus.

In some cases, an incision in the neck is made to gain access to the upper part of the esophagus for resection.

Patients who suffer from esophageal cancer can opt for a robotically assisted esophagogastrectomy. The da Vinci® Surgical System is a sophisticated robotic platform utilized by surgeons to expand their capabilities. Instead of performing the surgical procedure by hand, the healthcare providers maneuver a set of robotic arms outfitted with the necessary instruments.

The da Vinci® Surgical System has important benefits to offer to our Cedars-Sinai Marina del Rey Hospital patients:

  • less blood loss due to the surgery
  • shorter periods of time needed for recovery
  • improved pain management
  • minimal scarring

The robotic surgical system allows surgeons to perform esophagogastrectomy with better visibility, and with precision in maneuvering the surgical tools impossible to achieve by the human hands.

Removing the cancerous parts of the esophagus can be curative if cancer did not spread beyond this organ. If the procedure is performed on a patient with cancer that has spread to other organs, esopagogastrectomy can reduce and ease symptoms. For example, swallowing difficulties can be reduced, which improves the nutritional status of the patient.

The surgery can also slow down the process of metastasis, even if there are no expectations for curing the disease. Fewer complications and less pain occur for patients who had a laparoscopic procedure that requires small incisions compared to patients who undergo an open esophagogastrectomy.

The period of survival increases for patients that undergo chemotherapy and radiation treatments before and after esophagogastrectomy.

Before performing an esophagogastrectomy on a patient, the overall risks have to be determined. The healthcare provider must know beforehand if the patient is able to survive the perioperative stress.

Risk factors for morbidity or mortality that must be taken into consideration before the surgery:

  • advanced age
  • tumor stage
  • pulmonary dysfunctions
  • diabetes mellitus
  • cardiac dysfunctions
  • poor cardiopulmonary status

Complications associated with esophagogastrectomy involve:

  • infections
  • bleeding
  • leakage from the esophagus or stomach
  • lung complications
  • injury of the stomach, lungs, or intestines during surgery
  • not reacting well to anesthesia
  • heart attack during the procedure
  • severe heartburn

One or two weeks of hospital stay is usually needed after esophagogastrectomy. The patient should expect to wake up after the procedure with a number of tubes and catheters that help with the following:

  • to remove fluids from the stomach
  • to provide nutrition until the patient can eat on his/her own
  • to drain fluids from the chest area if necessary
  • to receive pain medication through an epidural catheter
  • to drain the urine in the first days after surgery

In about three weeks after the procedure, the patient can return to his/her normal activities. Also, a normal diet can be included in the patient’s lifestyle after a month. Because of a reduced stomach size, the patient will notice the need for smaller amounts of food for one meal. Patients can experience weight loss in this period of adjusting to the changes in their bodies.

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