Overview
A complex operation for a serious disease.
Esophagectomy is the operation that removes most or all of the esophagus — the muscular tube that carries food from the throat to the stomach. The most common reason to do it is cancer: adenocarcinoma of the lower esophagus or squamous cell carcinoma of the upper esophagus. Other indications include high-grade dysplasia or early cancer in Barrett's esophagus that cannot be safely managed endoscopically, end-stage achalasia, long strictures that no longer dilate, and serious esophageal perforation beyond repair.
Once the esophagus is removed, we have to reconstruct the swallowing pathway. The most common way is to make a tube out of the stomach (a gastric conduit), bring it up through the chest, and connect it to the remaining short cuff of upper esophagus. Whenever possible, we perform the operation minimally invasively — combining laparoscopic abdominal work and thoracoscopic or robotic chest work — which substantially reduces pulmonary complications and shortens recovery. Open Ivor Lewis or transhiatal techniques are reserved for cases where minimally invasive surgery is not safe.
Who is a candidate?
Candidates are adults with esophageal cancer that has not metastasized, with high-grade Barrett's dysplasia that endoscopic therapy cannot safely treat, with end-stage achalasia where the esophagus is irreversibly dilated and dysfunctional, or with long-segment strictures that no longer respond to dilation. Cardiopulmonary fitness, nutritional status, and prior abdominal or chest surgery all factor into the plan. We work closely with medical and radiation oncology so that patients who need chemotherapy and radiation receive it before surgery (neoadjuvant therapy), which is the standard for most locally advanced esophageal cancers.
How we perform it
Under general anesthesia, surgery proceeds in two stages: abdominal and thoracic. In the abdomen — minimally invasively whenever possible — we mobilize the stomach, preserve the right gastroepiploic artery, divide the left gastric vessels, perform a regional lymphadenectomy, and create the gastric conduit. In the chest, we mobilize and remove the diseased esophagus along with regional lymph nodes, then bring the gastric conduit up and create a hand-sewn or stapled anastomosis. A feeding jejunostomy tube is placed for nutritional support during the first weeks of recovery. The operation typically takes 5–7 hours.
Recovery
Hospital stay is typically 7–10 days. The first 24–48 hours are spent in a step-down or ICU bed with chest tubes and an epidural for pain control. Walking starts on post-op day one. Liquids start once a swallow study confirms the anastomosis is intact, usually around day five to seven. Tube feeding through the jejunostomy continues until oral nutrition is reliable. Full recovery to baseline activity takes two to three months, sometimes longer. Eating is in smaller, more frequent meals because there is no longer a reservoir-shaped stomach; our dietitian guides this transition.
Why Florida Surgical
Esophagectomy is one of the operations where surgeon and team experience matters most. The technical complexity is high, the margin for error is narrow, and outcomes depend on tight coordination with medical oncology, radiation oncology, nutrition, anesthesia, and ICU teams. Dr. Shaw is fellowship-trained in surgical oncology and complex foregut surgery, with experience in minimally invasive esophagectomy. We perform these cases at hospitals where the multidisciplinary infrastructure — thoracic anesthesia, dedicated ICU, ERAS protocols, and skilled bedside nursing — is built out to support them.
Frequently asked questions
Is esophagectomy the only treatment for esophageal cancer?
For most patients with cancer that has not metastasized, surgery is the cornerstone — almost always after chemotherapy and radiation. Very early cancers may be removed endoscopically; late-stage cancers may be treated with chemotherapy, radiation, and immunotherapy without surgery. We help you understand which path fits your stage.
Will I be able to eat normally after surgery?
Most patients return to a near-normal diet, in smaller portions and more frequent meals. The stomach is now both food pipe and stomach, so it holds less. Reflux, dumping, and changes in appetite are common early on and almost always improve. Our dietitian walks every patient through the post-op diet for the full first year.
How long is the hospital stay?
Typical stay is 7–10 days. Recovery to baseline activity at home takes two to three months. The first month is the slowest; the second and third are steady gains.
Is minimally invasive esophagectomy safer?
For appropriate patients, minimally invasive esophagectomy reduces pulmonary complications, blood loss, and pain — and gets patients out of bed and home faster. The choice depends on cancer location and prior surgeries; not every patient is a candidate. The oncologic completeness of the resection is the same with both approaches in expert hands.
Will I need chemotherapy or radiation?
Most patients with locally advanced esophageal cancer receive chemotherapy and radiation before surgery (neoadjuvant therapy) and sometimes adjuvant therapy after. Earlier-stage cancers are treated with surgery alone. Plans are set in a multidisciplinary cancer conference with medical oncology, radiation oncology, gastroenterology, and surgery.