If it is possible to cure cancer, the surgeon removes part or all of the esophagus. Number of resected tissue due to the localization of the tumor. There are several types of operations in esophageal cancer. All of them performed with general anesthesia.
If the tumor has penetrated the process in the stomach, it can be resected its upper part. Surgery to remove the esophagus in its entirety is called the total esophagectomy.
During surgery, doctors removed part of the lymph nodes around the esophagus, as they may contain malignant cells, broken away from the primary tumor. This resection reduces the risk of cancer in the future. Lymph nodes are then sent to a lab for testing. This will help set the stage of the cancer doctor and decide which treatments will be the best option.
The clinic Assuta - one of the largest network of private medical centers in Israel. Surgery is the most developed direction. At work here are invited to the best doctors in the country. All this - the factors that you should pay attention when choosing a hospital for surgery for esophageal cancer. Let us consider how to carry out surgical treatment of this disease in Assuta.
Transaction types in esophageal cancer
Select the type of surgery due to tumor location, stage of the disease, type of cancer of the esophagus, gradation, the general state of health and physical fitness.
At the initial stage of the disease it can be recommended to endoscopic mucosal resection. After that, you may need to radiofrequency ablation (RFA) or photodynamic therapy (PDT) for the destruction of the remaining abnormal or malignant cells.
It may be carried out an operation to remove the affected part of the esophagus and healthy segment body connected with the stomach, stomach pulling upward into the chest cavity. If it is not possible to use the stomach, used part of the intestine (colon), to replace the removal of the esophagus.
Also held a total esophagectomy - complete removal of the esophagus, stomach, then replace the esophagus.
Approaches to ehofagektomii
There are various ways to perform these operations in esophageal cancer. The surgeon may approach the tumor through the neck, chest or stomach area. Which of the approaches is suitable, the choice depends on the localization of tumors. Also, it is due to the preference of the surgeon. The patient may hear terms such as transthoracic esophagectomy or traskhiatalnaya - it approaches. The operation can also be called by the name of the surgeon who created it, for example, transthoracic esophagectomy refer to as Ivor Lewis operation.
Depending on the lead scar surgery can be:
- on his stomach;
- on the chest - right or left;
- on the neck.
Or maybe several.
Minimally invasive surgery for esophageal cancer
Laparoscopic surgery - quite a new approach that is becoming more common. Medical her name - transthoracic esophagectomy or minimally invasive esophagectomy. The surgeon makes 4-6 small incisions in the abdomen. It uses a tool that is a bit like soft and flexible telescope - a laparoscope. A laparoscope is connected to a fiber optic camera, which transmits the image. Inside it can be placed small appliances. The surgeon uses it during the surgery for esophageal cancer.
When it appends the remaining part of the esophagus to the stomach, it may be made a large incision in the abdominal cavity. Or physician will continue the operation by laparoscopy.
Laparoscopic surgery for cancer of the esophagus takes longer than abdominal - from 8 to 10 hours. In a small number of cases, the surgeon is forced to switch to open surgery. Minimally invasive approach provides less pain and more rapid recovery.
Preparation for surgery for esophageal cancer
Surgical treatment of esophageal cancer is preceded by tests that will determine whether the operation is suitable in a particular case. The following tests may be assigned for the diagnosis:
- Blood tests determine the overall health of the kidneys work.
- Chest X-ray examined the functioning of the lungs.
- ECG heart health checks.
- Breathing lyrics (pulmonary function tests).
- ECG exercise stress.
- Echocardiogram - diagnosis of heart using sound waves.
These tests determine whether the patient is healthy enough for general anesthesia and a further good recovery after surgery for esophageal cancer.
The patient communicates with the multidisciplinary team. Surgeon gives information about the operation, the benefits and possible risks of what to expect after the conference. Will meet with the anesthesiologist.
A physical therapist will teach special exercises to facilitate the recovery process. Breathing exercises reduce the chance of developing an infection in the lungs. Exercises for the legs prevent the occurrence of blood clots. In addition, physicians can assign preparations - injection of heparin, tinzaparin - preoperatively and for 4 weeks after. Also, the nurse will provide compression stockings at this time.
A nutritionist will assist and advise on the diet before and after surgery for esophageal cancer. It gives useful advice on how to increase the amount of nutrients and calories in snacks, meals and drinks. Prior to surgery may provide additional nutritional drinks. It may be necessary tube placement in the stomach or intestines to provide adequate nutrition before and after surgical treatment of esophageal cancer.
The patient in this period can ask any questions that he wants to get the answer. It will be helpful to write them. The more the patient is known, the less fear he would experience.
After the surgical treatment of esophageal cancer
The patient regains consciousness in a hospital intensive care unit. When the doctors to make sure that the patient gets better, move it to the House. As a rule, this takes day. Patient is provided with a thorough medical care, his condition is regularly checked. In connection with the effect of anesthesia and analgesics, the patient will feel sleepy. In some patients, the memory of the stay in the intensive care unit are matted and disoriented.
When the patient regains consciousness, he sees to it attached a variety of tube:
- Dropper through which blood transfusions and administered into the body fluid.
- Drains (one or more) of the chest region or abdominal cavity. Drainage may be in the chest, he ensures normal functioning of the lungs. As well as the drainage is placed in the abdomen to drain blood and fluid after surgery. They are usually removed after three to seven days.
- Catheter into the bladder to drain urine set.
Also located on the cannula into the artery to measure blood hand pressure. A pulse oximeter mounted on a finger to determine the pulse and blood oxygen level.
The patient may be given oxygen mask. The nurse will closely monitor the performance of blood pressure the first few hours after anesthesia. Will measure and record the amount of urinary diversion to know about excessive or insufficient amount of fluid in the body.
To an IV can be connected to the pump (electric pump) to manage any medication.
During the first week the patient will experience pain. There are many drugs - analgesics. It is important to inform the doctor in order to determine the type and dose of the appropriate analgesic drug. Maximum efficiency is achieved with regular admission.
After surgery, cancer of the esophagus to an IV pump may be attached (e-pump) with manual control. Press the button, the patient receives an additional dose of the drug. This so-called patient controlled analgesia. Overdosing is not possible.
It can be used an epidural in the first days after surgery. This is a very effective technique. The catheter is placed in the space around the spinal cord, while the patient is under anesthesia. The catheter is attached to a pump which delivers a continuous dose of analgesic.
Eating and drinking
After surgery, in any part of the digestive system of the intestines stop working for a while. Therefore, after surgery for esophageal cancer patient receives fluid through an IV. The doctor may be allowed to do a few small sips of water.
At the time of surgery can be set feeding tube into the jejunum. After 24 hours of surgery through it provide food. In some cases there is a need for intravenous nutrition, then involve parenteral nutrition.
The patient may be able to start drinking water in small quantities at 48 hours after surgery. Since surgery is concerned the esophagus, you need to eat very slowly. Usually begin with a small amount of clear liquid. Then increase the number and move on to other drinks - milk, tea and soup. Once the patient is able to drink without feeling sick, droppers extract.
Sometimes make an X-ray before the patient allowed to drink. Be sure there is no leakage between the esophagus and the stomach or esophagus and a portion of the intestine. The patient drinks the liquid dye which shows any leakage X-ray.
If the operation was carried out in the lower third of the esophagus, the valve has been removed in the top part of the stomach - esophageal sphincter. He held the penetration of the gastric contents into the esophagus. After surgery, the patient can detect acid reflux. To facilitate the state doctors prescribe antacids. can also help to stay in an upright position a couple of hours after eating. Your doctor may recommend sleeping in the bed, resting on a couple of pillows, and not lie flat.
For a speedy recovery nurse and physical therapist will encourage the patient to begin to move, to rise as soon as possible. They will help to sit after 6-12 hours after surgery for esophageal cancer. The next day will assist during a short walk around the bed. Within a few days the patient can walk with them in the hospital corridor. A physical therapist visits every day, working with the patient on breathing and exercises for the legs.
A few days after surgery the patient is able to walk, will gradually feel better. Will soon be able to eat more. First, it will be easier to eat small meals instead of three large three times a day. Throughout your stay at the hospital with the patient will work nutritionist. He will advise, help with diet, to make recommendations.
Clinic will be off after about 10 days after surgery.