Esophagectomy

Esophagectomy is surgery to remove the esophagus, the food pipe. Reconstruction restores the route for food. In the Ivor Lewis approach, the stomach is shaped into a tube, brought up into the chest and joined to the remaining esophagus. The blood supply to this stomach tube and the new join are important parts of the operation. Surgery for esophageal cancer also involves removing lymph nodes. Open and minimally invasive approaches are used; the exact reconstruction is a separate part of the surgical plan.

Surgery has an important role in treatment planned by several specialties for localized esophageal cancer. For locally advanced cancer, treatment can combine esophagectomy with drug treatment or radiotherapy. A separate choice concerns how the food passage is rebuilt: when the stomach cannot be used, a segment of small intestine or colon can be used instead. These are alternatives for reconstruction, rather than alternatives to cancer surgery itself.

In an Irish national-center series of 219 patients who had open surgery with the aim of cure between 2014 and 2018, the proportion who died within 30 days was 0%, and within 90 days it was 0.9%. The patients’ mean age was 67 years, and 77% were men. These are results from one center and treatment period, not an estimate of an individual patient’s risk.

A 2026 review combining eight studies and 6,053 patients with esophageal cancer compared open surgery with a hybrid minimally invasive approach. During the postoperative period, the hybrid approach was associated with less pneumonia, less loss of blood supply causing death of the reconstructed tissue, and less paralysis of the nerve controlling the voice box. The review did not find a statistically significant difference in deaths within 90 days or in hospital stay; this does not establish that the approaches are equivalent.

Lung complications are a major concern after esophagectomy. They can prolong recovery, affect quality of life and contribute to death. Another serious complication is a leak from the new surgical join. Assessment can involve examination, blood tests and imaging. Treatment options include supportive care, draining fluid and closing the defect.

Injury to the nerve controlling the vocal cords can affect the voice and allow food or fluid to enter the airway, potentially leading to pneumonia. The reconstructed stomach tube can also empty too slowly, causing fullness soon after eating, nausea, vomiting, food coming back up or difficulty getting enough nutrition by mouth.

Early recovery involves pain relief, a feeding plan and physiotherapy. Readiness to leave hospital depends on recovery milestones rather than a fixed number of days. Expert-agreed discharge criteria include meeting nutritional needs while taking at least liquids by mouth, with extra feeding through a tube into the small intestine if needed. They also include passing gas, not needing oxygen at rest or while moving, pain controlled with oral medicines, and stable clinical observations with improving blood markers of inflammation.

Persistent fullness, vomiting, nausea, food coming back up or difficulty eating enough can be assessed for slow emptying of the reconstructed stomach tube. Evaluation can include imaging that follows swallowed contrast through the food passage.