Minimally Invasive Esophagectomy at UPMC
Recently, doctors in the United States have been diagnosing more cases of esophageal cancer. Obesity and long-term irritation from gastroesophageal reflux disease (GERD) are believed to be contributors to this increase in new cases.
If you have esophageal cancer, you may be a candidate for a surgical treatment called Minimally Invasive Esophagectomy (MIE). At the UPMC Esophageal and Lung Surgery Institute, our surgeons are some of the most experienced in the world at performing the MIE procedure.
What Is Minimally Invasive Esophagectomy (MIE)?
MIE is surgery to remove cancer in the esophagus. The surgery involves small incisions through which surgeons insert a tiny camera and can remove cancerous parts of the esophagus and stomach.
The surgery may be performed with robotic assistance, providing surgeons with greater dexterity and the ability to access hard-to-reach areas of the body.
Surgeons at the UPMC Esophageal and Lung Surgery Institute use a multidisciplinary approach to determine the best combination of chemotherapy, radiation, and surgical treatment for each patient with esophageal cancer.
Benefits of Minimally Invasive Esophagectomy
The goal of MIE is to help you get back to a normal, cancer-free life. Minimally invasive techniques have made the procedure safer and recovery times shorter, providing patients with improved quality of life.
Compared to traditional open esophageal cancer surgery, using minimally invasive techniques — including robot-assisted surgery — greatly:
- Reduces the risk of complications
- Lessens pain
- Shortens hospital stays
For MIE surgery, a patient’s experience and outcome depend heavily on the expertise of the physicians and medical team performing the surgery. UPMC surgeons are among the most experienced in the world, having performed nearly 2,000 MIEs.
Preparing for Minimally Invasive Esophagectomy Surgery
Diagnostic tests and cancer treatment
To decide if MIE surgery is your best treatment option, you
will need to complete imaging procedures and other diagnostic testing. These
tests tell us the size and location of your tumor.
Tumors related to GERD tend to be lower, closer to where the
esophagus meets the stomach. Tumors caused by smoking and drinking alcohol tend
to be higher in the esophagus. Both types of tumors may be eligible for MIE,
but the number of incisions may vary based on the tumor's exact location.
Doctors approach the treatment of esophageal cancer with
multiple modalities. You may have chemo or radiation before MIE to shrink the
tumor. You may also need chemo or radiation after surgery. At the UPMC
Esophageal and Lung Surgery Institute, we'll work closely with you to develop
the best treatment plan for your condition.
Before the minimally invasive esophagectomy procedure
Your surgical team will provide you with details on how to prepare for your surgery. You can contact the team any time with questions about your minimally invasive esophagectomy.
To help you prepare, your doctor will give you a list of drugs to stop taking and a diet to follow.
Three days before surgery, you will begin a full liquid diet. This means only eating foods like cream soups, milkshakes, and smoothies. The day before surgery, this changes to a clear liquid diet. The night before surgery, you will need to do a gentle bowel prep and avoid eating or drinking after midnight.
Minimally Invasive Esophagectomy Procedure: What to Expect
When it’s time for your surgery, you will receive general anesthesia, which will cause you to sleep throughout the procedure. During the MIE, your surgeon will:
- Make small cuts in the chest, abdomen, and possibly neck
- Insert a tiny camera and surgical tools through these cuts
- Remove most of your esophagus and part of the stomach
- Reconstruct your stomach and connect it to the remaining part of the esophagus
If robotic-assisted surgery is used, you will have the same incisions and a similar camera and tools inserted.
The robotic technique provides the surgeon great precision. He or she is in control of every movement throughout the operation. The surgeon will sit at a console with a video screen that provides excellent visibility and control the surgical tools from the console to perform the procedure.
MIE surgery can last anywhere from 4 to 10 hours, with an average of 6 hours.
After the minimally invasive esophagectomy procedure
You will spend one night in the hospital intensive care unit before moving into a room on the thoracic surgery floor for recovery. You can expect to stay in the hospital for about six days.
At first, you will have a feeding tube in place for nutrition while the esophagus heals. Then, you'll begin a regimented diet. You'll start with liquids and slowly work your way back to eating solid foods. A dietitian will provide guidance on advancing your diet, along with oversight from your surgical team.
The team will watch you closely for complications while you’re in the hospital. We care deeply about your quality of life and about helping you get back to the things you enjoy.
After your release, if you have a fever or any signs of complications, call someone on your surgical team right away.
Within about three or four weeks, you’ll be able to resume many activities that aren't physically demanding.
The care team will follow up with you through regular outpatient clinic visits. Outside of those visits, you can contact us any time at the UPMC Esophageal and Lung Surgery Institute if you have questions or concerns.