Esophagectomy (Thoraco-Lap)

Thoraco-Lap Esophagectomy is the most advanced minimally invasive technique used in the treatment of Esophageal Cancer, a cancerous condition of your gullet (esophagus).


One of the few centers in the country.

World’s First Thoraco-Lap Esophagectomy in a HIV positive


3hr:00min

5

15

cancer of esophagus

A cancer that arises in the foodpipe or gullet is called as esophageal cancer. GERD, smoking and heavy alcohol drinking are usually the causes of cancer in the esophagus. Risk increases with age and is more common and dangerous in men than in women. This is also the fastest growing cancer in several parts of the world, including India.

Understanding Thoraco-Lap Esophagectomy

Thoraco-Lap Esophagectomy is a minimally invasive procedure in which the affected portion of the esophagus is cut and removed. Cancers like squamous cell carcinoma of the esophagus (type of cancer that involves the squamous cells of the esophagus), have a high recurrence rate. In such cases, the whole esophagus needs to be removed. This prevents further spread of the cancer to the stomach and surrounding organs. The first esophagectomy performed completely via laparoscopy was in 1995 by DePaul.

How is Thoraco-Lap Esophagectomy Performed?

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    3 small holes in chest and 4 small holes in the abdomen allows the surgeon to access the esophagus and the stomach.

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    Trocars and laparoscopic instruments are inserted and access port is created.

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    Through the four small holes in the abdomen, the stomach tissue is stretched and folded to create a stomach tube.

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    Via the three small holes in the chest, the esophagus is freed from all its attachments.

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    Finally through a small nick in the neck, the entire esophagus and the newly created stomach tube are pulled out.

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    The affected portion of the esophagus is then cut off and the unaffected portions are finally joined together.

thoraco-lap esophagectomy technique

Treatment window

Surgical treatment of Esophageal cancer must be initiated as soon as the condition is identified and confirmed. So as to avoid spread of cancer to nearby organs. Simultaneously Chemo and Radiotherapy should also be started at the earliest.

Life after THORACO-LAP ESOPHAGECTOMY

Patient will be on feeding tube for 1-2 months after surgery, until the sutures dissolve and the operated area heals. Regular tube care is advised.

After about 2 months, initially liquid diet is started then gradually progressed to soft diet.

Eating smaller meals throughout the day is advised.

video: lap esophagectomy

Thoracolap Esophagetomy FAQ

Smoking, Alcohol, tea, hot beverages, etc, have all been implicated, as has ingestion of smoked food. Probably the highest link between Esophageal cancer and preexisting disease is with reflux, as patients with acid reflux with waves of acid, banging against the wall of the gullet have a high incidence of developing Barret’s Esophagus, which, in turn often leads to cancer. Corrosive strictures, resulting from Phenol ingestion by persons attempting suicide, may also predispose to Cancer of the Esophagus.
An endoscopy, will give us a diagnosis and a biopsy done through the endoscope, is usually required for confirmation, before any further steps are actively taken. A CT Scan of the Chest or the abdomen is also very useful to evaluate for metastasis (spread to other organs like adjacent lymph nodes, the lungs or the liver).
Well, the answer is that if you are not chosen for surgery, it is probably bad news. Those patients who have advanced disease beyond the confines of the esophagus, or who are too sick to undergo a major procedure, are usually candidates of palliative treatment, which means we might just do an endoscopic stenting that permits the patient to swallow.
Through an endoscope we pass a guide wire, beyond the cancer, mark the confines/ extent of the cancer, and insert a metallic tube, which is telescoped within the tube of the gullet, beyond the cancer, both above and below. This permits the patient to swallow food and live life with a reasonable quality, until the inevitable happens.
Through keyholes in the abdomen an the chest, we will remove the entire gullet, create a new gullet by tabularizing the stomach and then lift this new gullet all the way up to stitch it to the upper food pipe in the neck.
It is not dangerous. But it is certainly a major undertaking. At LIMA, we have been doing these since 2002, and we have an extensive experience of the same. The advantage of keyhole surgery is that there is hardly any blood loss, pain or tissue trauma. Moreover, the optical magnification permits us to see all the nerves and blood vessels carefully, avoiding potential damage.
Depending upon the type of tumor (e.g: Squamous or Adenocarcinoma), or their spread to lymph nodes or the liver, and the grading of the tumor, we will opt to give an appropriate combination of Chemotherapy and Radiation in order to prolong life and improve quality for every patient with Cancer of Esophagus.

Thoracolap Esophagetomy Specialists

Dr. J. S. Rajkumar

CHIEF SURGEON

M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)


Dr. Prabhakaran Raju

Consultant Surgical Gastroenterolgy

M.B.B.S., M.S (GENERAL SURGERY), Mch(SGE)