Esophagogastrectomy

Pronunciation
Other names
Specialty
Uses
Complications
Approach
Types
Recovery time
Other options
Frequency

Esophagogastrectomy is a surgical procedure involving the resection of the esophagus and part of the stomach. This operation is typically performed to treat esophageal cancer, gastric cancer, or severe esophageal stricture.

Indications

Esophagogastrectomy is indicated in several medical conditions, including:

• Esophageal cancer: Particularly when the cancer is located in the lower third of the esophagus or at the gastroesophageal junction.
• Gastric cancer: When the cancer involves the proximal stomach and the gastroesophageal junction.
• Barrett's esophagus with high-grade dysplasia or early adenocarcinoma.
• Severe esophageal stricture that is refractory to other treatments.

Preoperative Evaluation

Prior to an esophagogastrectomy, a comprehensive evaluation is necessary. This includes:

• Endoscopy: To visualize the esophagus and stomach and obtain biopsies.
• Computed tomography (CT) scan: To assess the extent of the disease and check for metastasis.
• Positron emission tomography (PET) scan: To evaluate for distant metastases.
• Esophageal manometry: To assess esophageal motility, if needed.
• Nutritional assessment: To ensure the patient is nutritionally optimized for surgery.

Surgical Techniques

There are several approaches to performing an esophagogastrectomy, including:

Transhiatal Esophagogastrectomy

This approach involves an abdominal and cervical incision, allowing the surgeon to remove the esophagus and part of the stomach without opening the chest.

Transthoracic Esophagogastrectomy

This approach involves a thoracotomy, typically on the right side, to access the esophagus and stomach. It provides excellent exposure but is more invasive.

Minimally Invasive Esophagogastrectomy

This technique uses laparoscopic or robotic assistance to perform the procedure with smaller incisions, potentially reducing recovery time.

Postoperative Care

Postoperative management is crucial for recovery and includes:

• Nutritional support: Often via a jejunostomy tube initially, transitioning to oral intake as tolerated.
• Pain management: Using epidural analgesia or patient-controlled analgesia.
• Respiratory care: Including incentive spirometry and early ambulation to prevent complications such as pneumonia.
• Monitoring for complications: Such as anastomotic leak, infection, or stricture formation.

Complications

Potential complications of esophagogastrectomy include:

• Anastomotic leak: A serious complication that can lead to sepsis.
• Infection: Including wound infections and pneumonia.
• Stricture: At the anastomosis site, which may require dilation.
• Nutritional deficiencies: Due to altered gastrointestinal anatomy.

Prognosis

The prognosis after esophagogastrectomy depends on the underlying condition being treated, the stage of any cancer present, and the patient's overall health. Early-stage cancers have a better prognosis, while advanced cancers may have a poorer outcome.

See Also

• Esophagectomy
• Gastrectomy
• Gastroesophageal reflux disease

External Links

• [Link to relevant surgical society]
• [Link to patient information resources]