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ESOPHAGECTOMY
Esophageal
cancer may be treated with surgery, radiation therapy, chemotherapy,
or a combination of these three. An esophagectomy involves surgically
removing a large portion of your esophagus, then constructing
a conduit to allow you to eat. In most cases, the stomach is connected
to the remaining part of the esophagus. Occasionally a new passageway
is formed using tissue from other parts of the digestive tract.
Surgery for esophageal cancer is a major operation involving a
10-14 day hospital stay. This handout will help you prepare by
providing information on what to expect before, during and after
your hospitalization.
Cardiovascular
Surgery Associates, P.C. 4230 Harding Rd., Suite 501 Nashville,
TN 37205 (615) 385-4781
Preparing
for surgery
1) Good nutritional
status is very important. If you are unable to eat a balanced
diet, you may require supplemental nutrition by way of a special
feeding tube sutured into your small intestine.
2) Get as much exercise as you can to improve your overall physical
conditioning. Walking, biking, and swimming are all good cardiovascular
activities. Design a plan that will work for you and follow it.
Once you return home from the hospital you will have a good foundation
on which to build.
3) Depending on other health concerns, your surgeon may ask you
to see other health care providers (for example, a cardiologist)
prior to surgery to optimize your physical condition.
4) You will have pre-surgical testing, to include blood work,
urine studies, and an EKG. You will meet with your anesthesiologist
and receive instructions on breathing exercises from a respiratory
therapist.
The
day before surgery
1) You may have clear liquids only the day prior to surgery. To
adequately clear your digestive system, you will take medicine
(Golytely) prescribed by your surgeon that evening. You may have
nothing to eat or drink after midnight.
2) Bring to the hospital any medications you take on a regular
basis, as well as any personal items you may want to have. Any
valuables (jewelry, money, credit cards, etc.) should be left
at home. Please call us at 615-385-4781 if you have any questions.
The
day of surgery
1) Final preparations
will take place in the cardiothoracic surgery holding area. Your
family should wait in the Family Waiting Room on the first floor.
When surgery is complete (anticipate 5-6 hours), your family will
meet with the surgeon for an update on your condition. They will
be allowed to see you after you have transferred from the surgical
recovery room.
2) Because this is a major operation, you will awaken from surgery
with a lot of dressings and tubes. Please remind yourself these
are temporary! You may expect:
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a)
An abdominal incision and either a left neck or right lateral
chest incision, depending on the location of your tumor. These
will initially be covered with a dressing. Your incision is
closed with surgical sutures underneath the skin that do not
need to be removed in addition to metal skin clips which will
be removed approximately one week following your surgery.
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b)
A small drain in your neck or chest tubes, depending on the
surgical approach (usually removed 3-4 days post-op).
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c)
A Foley catheter in your bladder to assess your kidney function
(usually removed 3-4 days post-op or after the Epidural catheter
is removed).
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d)
A jejunostomy tube (J-tube), sutured to your abdomen. This is
a feeding tube connected directly to your small intestine. You
will not be permitted to eat for several days following surgery
while your incisions heal. During this time you will receive
nutritional feedings through this tube. Once you are able to
eat, these feedings will be discontinued. The tube, however,
will remain in place in case it is needed later. It is usually
removed when you return for your first post-operative visit,
three to four weeks following discharge.
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e)
A naso-gastric (NG) tube inserted through your nose to your
stomach. This tube keeps your stomach decompressed and removes
secretions until the surgical site is healed. This will stay
in place approximately one week. During this time, you will
not be allowed to eat or drink. Your first "meal"
will consist of a barium solution 7-10 days after the operation.
Barium shows up on x-ray and allows the surgeon to visualize
flow through your new conduit and ensure it does not leak. Once
you pass your barium swallow test, foods will be gradually introduced,
beginning with liquids.
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f)
Monitoring intravenous lines (IV) will be placed by anesthesia
and usually includes an arterial line at your wrist and a special
line in a large vein either at your neck or clavicular area.
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g)
Supplemental oxygen by way of a small nasal cannula.
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h)
An Epidural catheter in your back provides continuous pain control.
Following
surgery
Family: As you recover from surgery, you will transfer
to either the Intensive Care Unit or to a regular room. Once in
a regular room, your family will be able to stay with you during
the day and one person may remain with you at night.
Activity: It is very important that you use your incentive
spirometer every hour while you are awake, 10-15 repetitions.
This will help prevent complications from pneumonia. It is also
important to increase your activity. Your nurses will help you
move from bed to chair and assist you as you walk up and down
the hall.
Diet: For the first few days, you will not be allowed to
eat. It will take time for your bowels to recover from anesthesia
and for your body to adjust to your new anatomy. Be patient with
yourself.
Discomfort: Initially, you will be able to control any
discomfort with intravenous pain medication delivered by either
an Epidural catheter or by a patient-controlled pump. As you heal,
you will begin oral pain medication. It is very important to let
your doctor and nurses know how you feel so we can work together
to keep you comfortable.
Going
home!
Caring for your incisions
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Wash
your incisions every day with soap and water.
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You
may shower and bathe as usual.
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You
may feel numb around your incision. This is normal.
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There
may be pieces of tape across your incision. These may be removed
as they become loose or one week after discharge from the hospital,
whichever comes first.
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A
dressing is optional.
Caring for your feeding tube
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Your
feeding tube (jejunostomy tube) is secured to your body with
a suture. It should remain clamped unless you are using it to
supplement your diet.
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Clean
around the tube with water before and after you use it for feeding
and three times a day. Be sure to flush the tube daily as instructed.
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If
the tube should come out when you are at home, contact your
doctor or nurse at (615) 385-4781 or go to the nearest emergency
room.
A small amount of drainage around the tube is normal. Notify
us if it becomes foul smelling or if you develop a temperature
of greater than 101.
Exercise
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Increase
your activity every day. Walking is good exercise for your lungs
and heart and may also help you digest food better.
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It
is normal to feel tired for 6-8 weeks after discharge.
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Do
not lift anything heavier than a gallon of milk for 4 weeks.
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Do
not engage in active exercise such as swimming, tennis, or golf
for 6 weeks.
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You
may resume sexual activities whenever you desire.
Diet
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You
may eat regular soft food as you are able, unless you have been
placed on a special diet.
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Introduce
new foods cautiously. Spicy foods, sweets, and milk products
may cause abdominal cramping or diarrhea.
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A
well-balanced diet will assist in the healing process. Ask your
hospital dietitian for more information.
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If
you need supplemental tube feedings, continue them as you were
instructed in the hospital. It is best to eat 4-6 small meals
a day. Try to avoid drinking with meals, as food will pass through
your digestive system much faster.
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Because
your stomach now empties by gravity, be sure to eat upright
and remain upright for at least 1/2 to one hour following meals.
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Depending
on your type of surgery, you may swallow a little differently.
Some foods may be swallowed easier than others. You should always
use a straw when drinking to decrease gas.
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It
is important to eat well and maintain your weight. You are encouraged
to weigh yourself the day you get home, and continue weighing
yourself twice a week. Keep a record of your weight.
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If
you lose more than 3 pounds from your weight on the day you
arrived home, notify Cardiovascular Surgery Assoc., P.C. at
(615) 385-4781.
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If
you develop persistent nausea, vomiting, diarrhea or constipation,
contact Cardiovascular Surgery Assoc., P.C. at (615) 385-4781.
You may have softer stools if you are receiving tube feedings.
Laxatives
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You
may have constipation because of the change in activity associated
with your hospital stay, surgery and the use of pain medicine.
Increasing your activity daily, eating well and drinking plenty
of fluids will decrease problems with constipation. You may
use commercially prepared laxatives if needed.
Home Care Supplies/Services
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If
there is a need for home care services or a pump for tube feedings,
necessary arrangements will be made prior to your discharge
from the hospital.
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Special
Instructions
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Once
you are at home, it is important to never lie flat.
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Keep
the head of your bed raised like it was in the hospital, at
an incline of approximately 30°.
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Try
one of the following methods:
Put a wedge foam under your pillow and chest.
Put a wedge form at the head of the bed between the box springs
and mattress.
Raise the head of your bed using bricks or cinder blocks.
Build an inclined bed (see attached).
Other
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You
may continue to have some discomfort for a month or more as
a result of your operation. This should gradually lessen. You
will be given prescriptions for pain medicine at discharge.
Remember, you should not drive when taking prescribed pain medicine.
You may take an aspirin-free drug like Tylenol© as needed
after you have finished all the medicine prescribed by your
doctor.
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