Assuta surgeons perform complete or partial minimally invasive esophageal resections primarily to treat esophageal cancer.

In most cases, patients undergo the surgery during stages 1 or 2 of the disease, when the cancerous
tumor is localized in the esophagus, and has not spread to other areas. The operation is often complex,
involving multiple areas of the body. It includes resection (cutting out part or all) of the esophagus and
part of the stomach,followed immediately by reconstructing the upper gastrointestinal tract.


About the esophagus

The esophagus is a long muscular tube. It connects the pharynx (cavity behind the nose and mouth) to
the stomach and involves three separate anatomical areas: the neck, chest, and abdomen. When a
person swallows, the esophageal muscles contract to move food down to the stomach.
Resection surgery is done through the patient’s abdomen, chest, or neck under general anesthesia.


Reasons for needing esophageal cancer surgery


Achalasia

Achalasia is a condition in which the muscles in the lower part of the esophagus do not open and expand
when food passes through the esophagus. This can cause severe difficulty in swallowing almost any kind
of food. If medicines to relax the esophageal muscles do not help to improve the condition, the patient
may require surgical intervention.


Achalasia surgery

Two surgical options are available at Assuta:

  • Inserting a surgical balloon through the pharynx, which will gradually cause the muscles to
    expand (operation performed under local anesthesia)
  • Cutting these muscles to allow food to pass more smoothly

Esophageal duct stenosis

There are various reasons that the esophagus narrows and contracts – either at certain points in the
esophagus or along the entire length of the esophagus, making it difficult to swallow and pass food.
Varicose veins, drinking caustic substances derived from bleach, and prolonged gastroesophageal reflux
are some of the causes of esophageal strictures.


Esophageal duct stenosis surgery

Surgical interventions in these cases are similar to the treatment of achalasia: inserting a special balloon
through the pharynx in order to gradually expand the inner part of the esophagus (performed under
local anesthesia).


Tumors along the esophagus

Tumors along the esophagus will also cause it to function improperly. These can be benign or malignant
(cancerous) tumors. With malignant tumors, there is a risk that the cancer will spread to nearby organs.


Treatment of esophageal tumors

The surgeon makes a tiny incision in the chest wall and abdomen, through which he or she inserts a
surgical instrument and tiny camera to view the surgical field on a computer screen. There are two main
types of tumor removal; the choice of procedure is made based on the tumor location and personal
preference (if possible):

  • Subtotal resection of the esophagus: In this operation, most of the esophagus and the upper
    part of the stomach are removed. The remaining stomach is then attached to the esophagus to
    maintain gastrointestinal continuity.
  • Partial resection of the esophagus and stomach: In this surgery, the lower part of the esophagus
    and part of the upper stomach are removed. The remaining stomach is then connected to the
    esophagus to maintain gastrointestinal continuity.
    After either surgery, the medical team scans the area around the esophagus, and the lymph nodes are
    removed and sent to the lab for evaluation to see if the tumor has spread to them. Based on the lab
    results, the team decides if additional treatment is required, such as radiation or chemotherapy.

Potential complications of esophageal resection surgery

Esophageal resection is complex surgery, which is why complications can be more common than simpler surgeries. Because the surgical connection area between the esophagus and stomach is relatively large, the chances of leakage and subsequent infection are greater. However, most complications can be treated with a conservative intervention or endoscopic procedure.