Surgical treatment of esophageal cancerSurgery - treatment of esophageal cancer. Most often performed esophagectomy using different approaches. The doctor recommends that the best technique depending on the location of malignancy and the presence / absence of secondary lesions.

If a patient goes to an Israeli hospital, they engaged a team of experts - oncologists, surgeons, radiation therapists, pathologists and other specialists. Inthe treatment of esophageal cancer are offered a variety of innovative methods:

  1. Minimally invasive surgery and procedures, including the FTD.
  2. Endoscopic surgery for esophageal cancer in the early stages.
  3. Other specialized surgical procedures.
  4. Proton therapy.
  5. Targeted therapies.
  6. Participation in clinical trials.

If you are diagnosed with - cancer of the esophagus, our company can help. MS «Tlv.Hospital» organizes treatment in Israel - from the best doctors in the shortest possible time, providing the most comfortable conditions of stay in the country.

Let us consider the possibility of surgical treatment of esophageal cancer in medical centers in Israel.

Surgery is recommended in the following situations:

  1. To completely remove the tumor and cure cancer.
  2. Resect the maximum amount of tumor, before resorting to other methods of treatment.
  3. Restore the gastrointestinal tract after the removal of the esophagus.
  4. Ease the symptoms of the disease at later stages in the presence of metastases.

Evaluation before surgical treatment of esophageal cancer

The patient should be healthy enough to undergo surgery. Since it is a complicated procedure, after which it is difficult to recover. Carry out a thorough assessment. It may include the following types of diagnostics:

  1. We study history, a physical examination is performed. The doctor asked about the potential of earlier operations in the abdominal cavity - in the stomach or large intestine. As this may affect the ability of the digestive tract reconstruction after removal of the esophagus.
  2. Blood tests can be assigned: clinical, biochemical, coagulation (clotting), liver function tests.
  3. Diagnosis of heart and lungs to check their work. It is very important to stop smoking before surgery.
  4. Evaluation of weight loss and nutrition. People with esophageal cancer often malnourished, which leads to weight loss. Therefore, it needs help to gain weight, improve nutrition and health. May require the intake of dietary supplements, placing feeding tubes or intravenous nutrition.

On the choice of type of surgery for esophageal cancer affects the size, stage and location of the tumor, the presence or absence of previous surgical procedures, the patient's age and his health.

Esophagectomy - surgery for esophageal cancer

This surgery, in which a segment is removed completely and the entire esophagus. This operation is performed most often in esophageal cancer. There are three types of esophagectomy.

  1. Total esophagectomy - the most preferred type of surgery involves resection of the esophagus and surrounding lymph nodes.
  2. Partial esophagectomy is performed when the tumor process hit a large part of the stomach. Remove the tumor in the esophagus and located next to the lymph nodes.
  3. Resection of the esophagus and the proximal part of the stomach is performed when the cancer is located in the lower part of the body; in the transition between the esophagus and stomach; in the upper part of the stomach. The operation is carried out removal of the affected segment of the lower esophagus and 8-10 cm of healthy tissue, the upper portion of the stomach and nearby lymph nodes.

Reconstructive surgery for esophageal cancer

Reconstructive surgery helps to restore the functioning of the digestive tract after resection of cancer. Select the type of surgery and the approach takes into account all the peculiarities of a particular situation - health status, location and size of a tumor prior to treatment. Also important criterion is the surgeon's preference and experience in the operation. Typically, the reconstruction is performed immediately after removal of the tumor.

Plastic with the help of the stomach

When completely resected segment or the entire esophagus, the best option - tighten up the stomach, to form a tube therefrom and connected with the remaining part of the esophagus (esophageal-gastric anastomosis).

Reconstruction with the help of the colon or small intestine

Restoring using colon (thick portion) or the small intestine is performed if the stomach can not be used for reconstruction. The surgeon will apply bowel segment to replace the esophagus.

Approaches to surgery for esophageal cancer

There are several approaches to surgery to remove part or all of the esophagus. In terms of efficiency there is no difference in these approaches.

Cavity (outdoors) approach

Operation in esophageal cancer may be made by the long incisions in the abdomen, chest or neck. After surgery, placing a feeding tube in the stomach or the middle part of the small intestine (jejunum). That allows the patient to recover after surgery and obtain the necessary nutrients.

Transkhiatalny approach

This abdominal surgery, which is performed at a cancer of the lower esophagus. But also it can handle, if the tumor is located in the middle and upper part of the body.

The surgeon makes an incision in the abdomen (from the bottom of the sternum to the navel). Stomach and lower esophagus release from fabrics. Removes the tumor, part of the stomach, nearby lymph nodes.

It makes an incision on the left side of the neck. Releases the upper and middle part of the esophagus from tissue. Format a stomach tube, leads to neck and impose anastomosis.

transthoracic approach

Another name - an approach Ivor-Lewis. It is used if the tumor is located anywhere along the entire length of the esophagus.

The surgeon performs incision in the abdominal cavity. The stomach releases from the tissues that hold it in place, and left in the thoracic cavity. Opens the chest on the right side. Removes the diseased area of ​​the esophagus or all of the body and the surrounding lymph nodes. From the stomach and forms a tube connects to the remaining part of the esophagus.

thoracoabdominal approach

It is used in the treatment of esophageal cancer in the lower body segment or the upper part of the stomach.

The surgeon makes an incision in the middle of the abdominal cavity upward to the left side of the chest. Removes the affected area or the entire esophagus. From the stomach forms a tube, it tightens up and connects to the remaining segment of the esophagus

radical esophagectomy

This approach is used when the tumor is located in the lower third of the esophagus or gastroesophageal transition zone that can spread to the surrounding structure. Held at 1-3 stage disease.

This more extensive operation, during which the esophagus is removed, the tissue surrounding the abdominal cavity and mediastinum adjacent lymph nodes, spleen, large part of the stomach.

The following structures may also be removed: part of the diaphragm, thoracic duct (largest lymphatic vessel in the chest), a part of the pericardium and pleura segment.

The stomach is connected to the remaining segment of the esophagus. If the stomach can not be used for reconstruction, the segments of the colon or the small intestine are used.

laparoscopic esophagectomy

During such low-invasive surgery for esophageal cancer uses laparoscope surgeon performs surgery in 4-6 small incisions.

Laparoscopic esophagectomy - a specialized method that is not available in all medical centers in Israel. As a rule, used in the treatment of early stage of esophagus cancer.

The indication for such an operation is a tumor located anywhere along the entire length of the esophagus. Generally, laparoscopic esophagectomy carried out using a combination of laparoscopic and thoracoscopic approaches.

Laparoscopic surgery for esophageal cancer provides faster recovery times, fewer complications compared with cavitary intervention.

Tumors of the esophageal-gastric junction

When such malignancies usually carried total gastrectomy.

Palliative surgery for esophageal cancer

By surgery also seek to alleviate the symptoms of metastatic cancer. The main objective - to improve the health and condition of the patient, improve the quality of life and to get rid of problems with swallowing.

bypass

Surgery for esophageal cancer can be carried out, that change the direction of the flow of food or fluid around the tumor, which caused a fistula between the trachea and the esophagus. This option is used when the patient's state of health does not allow to install a stent. During pull up bypass the stomach and the esophagus is connected to the above mentioned localization neoplasms bypassing it, so.

esophagectomy

This operation for cancer of the esophagus is carried out, if a person is healthy enough to move it. Removing a part of or the entire esophagus. Typically, the surgeon connects the remaining part of the esophagus and stomach.

feeding tube

Feeding tube used to provide a liquid diet to the patient with cancer of the esophagus and help maintain weight. Through it may also deliver drugs.

In the presence of metastases may require the probe before surgery, during the meeting or during the subsequent recovery. Such a probe can be used when other methods do not eliminate the blocking provoked by the tumor.

Depending on the type of surgery and reconstruction, a feeding tube is placed through the nose into the stomach (nasogastric) or by gastrostomy operation. The probe may be installed in the small intestine. If surgery is not planned, the endoscope is used to place the probe into the stomach.

After surgery for esophageal cancer

The patient will tell in detail in advance what to expect after surgery. information will be provided:

  • of exercises for the legs and breathing, to prevent possible complications;
  • any dropper and devices will be applied (drainage, feeding tube or parenteral nutrition);
  • changes in diet required after discharge from the hospital.

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