Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical phary
CPT4 code
Name of the Procedure:
Total or Near-Total Esophagectomy with Thoracoscopic Mobilization
- Medical Terms: Esophagectomy, thoracoscopy, laparoscopy, pyloric drainage, cervical pharyngoesophagectomy.
Summary
Esophagectomy is a surgical procedure that involves the removal of all or part of the esophagus. This surgery uses minimally invasive techniques to free the esophagus from the chest area (thoracoscopic mobilization) and the upper stomach (laparoscopic proximal gastrectomy), often including drainage of the stomach’s pylorus (pyloric drainage) and reconstruction connecting the back of the throat to the stomach (open cervical pharyngoesophagectomy).
Purpose
The primary purpose of an esophagectomy is to treat esophageal cancer or severe damage to the esophagus. The procedure aims to remove cancerous tissues and restore the ability to swallow by reconstructing the gastrointestinal tract.
Indications
Symptoms/Conditions:
- Esophageal cancer
- Barrett's esophagus with high-grade dysplasia
- Severe traumatic injury to the esophagus
- Strictures or blockages not amenable to other treatments
Patient Criteria:
- Patients with localized esophageal tumors
- Patients in good general health
- Patients who have not responded to other treatments
Preparation
Pre-procedure Instructions:
- Fasting from midnight before the surgery.
- Stopping certain medications as advised.
- Pre-surgical bath with antiseptic soap.
Diagnostic Tests:
- Blood tests
- Imaging studies (e.g., CT scan, PET scan)
- Endoscopy
- Pulmonary function tests
Procedure Description
- Anesthesia: General anesthesia is administered.
- Thoracoscopic Mobilization: Small incisions are made to insert a camera and instruments to free the esophagus from the mediastinum.
- Laparoscopic Gastrectomy: Similar small incisions are made in the abdomen to remove the proximal part of the stomach.
- Pyloric Drainage: If necessary, a procedure is performed to help the stomach drain more easily.
- Cervical Pharyngoesophagectomy: An open incision in the neck is made to remove the upper part of the esophagus and connect the remaining esophagus to the stomach or intestine.
- Reconstruction: The gastrointestinal tract is reconstructed to restore continuity from the throat to the stomach.
Duration
The procedure typically takes between 5 to 8 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Surgeons specializing in thoracic surgery.
- Nurses and surgical assistants.
- Anesthesiologists.
Risks and Complications
- Common Risks:
- Infection
- Bleeding
- Leakage at surgical connections
- Rare Complications:
- Respiratory complications
- Long-term swallowing difficulties
- Anesthesia-related complications
Benefits
- Expected Benefits:
- Removal of cancerous or damaged tissue
- Restored ability to swallow
- Timeline: Benefits are typically observed after the initial recovery period, within a few weeks to months.
Recovery
- Post-procedure Care:
- Hospital stay for 1-2 weeks
- Tube feeding for nutrition initially
- Gradual introduction to solid food
- Recovery Time:
- Complete recovery may take several months.
- Restrictions on activities and follow-up appointments for monitoring healing.
Alternatives
- Other Treatment Options:
- Endoscopic treatments (for less advanced cases)
- Radiation therapy
- Chemotherapy
- Pros and Cons:
- Alternatives may be less invasive but might not be as effective for advanced conditions.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any pain. After the procedure, the patient may experience discomfort, pain, and difficulty swallowing, which will be managed with pain relief and supportive care. The hospital team will focus on pain management, infection prevention, and ensuring proper nutrition during the initial recovery period.