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Esophageal Cancer and its Surgical Treatment

In the case esophageal cancer is diagnosed in its early stages, the common treatment method is surgery. It is very important to diagnose esophageal cancer in its early stages for effective treatment. It is essential that a detailed examination and testing is done (barium swallow test, upper GI endoscopy, lung tomography, head MRI scan, pulmonary function test) to determine what stage the cancer is in.

The operation method and which side the operation will be conducted on depend on the location of the esophageal cancer, its size, its relation with the surrounding organs and cell type. The main goal is to remove the entire cancerous tissue (part or all of the esophagus). In these operations commonly part of the stomach is pulled up to become the new esophagus. In other cases colon or the jejunum are used to become the new esophagus. In all of these operations lymph nodes are removed, providing a more curative treatment.

Duration of the procedure: If cancerous tissue will be removed without neck dissection the procedure takes relatively shorter (4 – 5 hours), but if the entire esophagus will be removed and anastomosis used, the surgery takes up to 6 – 7 hours. Duration varies depending on the case.

The Procedure:

The patient lays on her back under general anesthesia. Laparoscopy and laparotomy are used to prepare the stomach for the procedure. After the stomach is prepared, depending on the condition of the patient, Ivor – Lewis method (from the right pulmonary cavity level with azygos vein), Sweet procedure (from the left pulmonary cavity level with aortic arch) or anastomosis in the neck is used. The patient’s position is changed during the operation, depending on the preferred method.

Straight and circular staplers are used to connect the esophagus and the stomach after the stomach is prepared for the operation. Following this step cancerous tissue is removed and operation is finalized. The removed lymph nodes must be numbered correctly to get correct results from pathology report. The evaluation of the pathology report will help assess the situation correctly and decide whether further treatment (chemotherapy or radiotherapy) is necessary.

Following the Procedure:

The patient starts daily walks on the following day of the procedure. For 4 days nothing is consumed through the mouth. At the end of the fourth day checks are made to see whether there is any leakage from the esophagus, and if there isn’t the patient starts to consume water and liquid foods. TPN (total parenteral nutrition) is used starting from 1 week prior to the operation and also following the operation. If there are no complications the patient is discharged in 7 – 10 days.

The patient is prescribed painkillers and antibiotics for 10 days. Commonly, patients get back to their daily lives within 2 – 3 weeks. Following the procedure it is essential that patients take 30 – 45 minute walks daily. Pathology report is given in about a week. The report must be assessed by an oncology department

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