Esophagectomy

Most people with esophageal cancers can achieve long-term disease control with a combination of esophagectomy, chemotherapy and radiation therapy. Esophageal cancer surgery alone also often provides good outcomes for people with early-stage esophageal cancers.

At Penn Medicine, we are an ultra-high volume center for esophagectomy. And our experience matters — studies show that patients have the best possible outcomes when experienced surgeons in high-volume hospitals perform this procedure.

What Is an Esophagectomy?

Esophagectomy is the most common form of surgery for esophageal cancer. During the procedure, surgeons:

1. Remove all or part of your esophagus and nearby lymph nodes through incisions in your chest, abdomen or both
2. Reconstruct the esophagus using the stomach or colon

Esophagectomies are major operations — surgeons must cross two to three body cavities (abdomen, chest and neck) during the four- to six-hour procedure. Patients then recover in the hospital for about eight days.

Esophagectomy Types

While there are different types of esophagectomies, your Penn surgery team will most likely use minimally invasive techniques like laparoscopy to remove the cancer and nearby lymph nodes. Laparoscopy can be done through several small incisions, which are likely to reduce pain and lead to a faster recovery time than open esophageal surgery. A pathologist (lab specialist) with special expertise in GI cancers then examines your lymph nodes to see if the cancer has spread.

The location of the tumor within your esophagus determines the type of surgery you have. We offer three types of esophagectomies:

• Transhiatal esophagectomy
• Ivor Lewis esophagectomy
• Thoracoabdominal gastrectomy

Transhiatal Esophagectomy

Transhiatal esophagectomy is the most common type of esophageal cancer surgery we perform. This approach involves only a neck incision.

During a transhiatal esophagectomy, we:

1. Remove most of your esophagus and a little bit of your stomach
2. Bring the rest of your stomach up to your neck and attach it to the remaining esophagus

Ivor Lewis Esophagectomy

Ivor Lewis esophagectomies are the second most common type of esophagectomy we perform. This approach involves incisions in the abdomen and chest. During this procedure, we:

1. Remove part of your esophagus
2. Make a tube (conduit) out of part of the stomach
3. Connect the stomach conduit to the esophagus in your chest

Thoracoabdominal Gastrectomy

The thoracoabdominal approach is the least common. We use it when a tumor is in your lower esophagus or gastroesophageal (GE) junction (where your esophagus joins your stomach).

During this procedure, we:

1. Make an incision in your abdomen that goes to the left side of your chest
2. Divide your esophagus in the left chest
3. Bring either your stomach or small intestine up to your left chest to create a new connection

Esophageal Cancer Surgery: Why Choose Penn Medicine?

As one of the largest gastrointestinal (GI) surgery programs in the U.S., we offer the most advanced surgical treatments for esophageal cancer. You also benefit from:

• Experience: On average, our surgeons perform at least 70 esophagectomies each year in a dedicated esophageal surgery unit. Hospitals that do 12 surgeries annually are considered high-volume centers. Our exceptional experience improves your chance for a good result.
• Minimally invasive options: Our surgeons use minimally invasive approaches in more than 90 percent of esophagectomies. These techniques reduce pain and recovery times.
• Team approach: Successful esophageal cancer treatment often involves a combination of surgery, chemotherapy and radiation therapy. To ensure seamless care, your medical team includes experts in gastroenterology, medical and radiation oncology, and GI and thoracic (chest) surgery — all working together in your behalf. Experienced nurses round out your care team and support you before and after surgery, in the hospital and at home.
• Faster recoveries: We use enhanced recovery after surgery (ERAS) protocols to help you recover faster. These strategies help you better manage pain and shorten your hospital stay.
• Focus on your quality of life: Esophageal cancer surgery affects how you eat, digest and enjoy food. Our goal is to get you back to eating for both nourishment and pleasure. We help you relearn how to eat to digest properly and savor the foods you love.
• Endoscopic treatment options: If you can't have surgery or need symptom relief before or after esophagectomy, we offer comprehensive endoscopic options. These minimally invasive treatments include the use of an expandable stent (tube) to keep your esophagus open if the tumor blocks it.

Supporting You Through Esophageal Cancer Surgery

At Penn, we provide complete care before, during and after your surgery. That's why your care includes:

• Cancer counselors to provide individual and family counseling when needed
• Esophageal cancer support group that connects you with others who have gone through an esophagectomy
• Oncology nurse and patient navigators to help you navigate our health system
• Registered dietitians to help maintain your nutrition
• Smoking cessation program to increase your chances for a successful surgery 

What to Expect After Esophagectomy

We help you recover, adjust and thrive in the days, weeks and months after your surgery. Here are some milestones that happen after your procedure:

• 48 hours or less: You get out of your hospital bed and walk.
• About eight days: You go home with a temporary feeding tube. The feeding tube generally stays in place for six to eight weeks.
• Three weeks after surgery: You undergo a swallow study. If the connection is healed, you go through about a 10-day diet transition from clear liquids to full liquids and then to soft foods.

Read common FAQs about esophagectomy surgery.

Request an Appointment

Call 800-789-7366 or request a callback.