1.What are the surgical options?
There are various surgical options for esophageal cancer, which can be divided into trans-left thoracic esophageal cancer resection, trans-right thoracic epigastric esophageal cancer resection, trans-right thoracic epigastric left cervical esophageal cancer resection, open thoracic esophageal dissection, and the recent emergence of total lumpectomy for esophageal cancer. According to the different areas of lymph node dissection, it can be divided into two-field lymph node dissection, modern two-field lymph node dissection and three-field lymph node dissection.
2.How is the surgery done?
It can be roughly divided into esophageal cancer resection and digestive tract reconstruction. It mainly includes free esophagus + chest lymph node dissection, free stomach + abdominal lymph node dissection, and gastroesophageal anastomosis.
3.What are the risks of surgery?
The risks of esophageal cancer surgery include bleeding, pulmonary complications, cardiac complications, anastomosis-related complications, adjacent organ injury complications, and incision-related complications. Pneumonia and respiratory failure are common complications. Anastomotic fistula is a more serious complication. Hemorrhage, ARDS, tracheoesophageal fistula, pulmonary embolism, cardiac infarction, cerebral infarction, and multiple organ failure are serious complications with low incidence but high mortality. Overall, most patients can pass the surgery and rehabilitation level.
4.Can I sign the pre-surgery talk alone?
The pre-surgical talk needs to be attended by both the patient and the family. The conversation will include the surgical plan, the expected efficacy of the surgery and the possible risks during and after the surgery. The patient and the family will discuss together and sign together if they agree to the surgery.
5.What do I have to do before surgery?
If the patient smokes, try to quit smoking for 2 weeks before surgery, so as to reduce postoperative respiratory secretions. After admission, start cardiopulmonary exercise, such as practicing the correct way to cough and climbing stairs.
6.Can I eat the first day before surgery?
You can have semi-liquid food for breakfast and lunch on the day before surgery, and liquid food for dinner.
7.What should I do if I am nervous and cannot sleep before surgery?
You can take oral sleeping pills.
8.How long does the surgery take?
Usually the operation time is about 3-8 hours. However, the operation time should be determined by the specific situation during the operation.
9.What do I have to do after surgery?
First of all, you should actively cough and cough up sputum for 5-10 minutes every hour, and cough up sputum before going to sleep. Secondly, after surgery, there are chest tube, gastric tube, nutrition tube, deep vein cannula and urinary catheter, etc. The tubes cannot be removed without the doctor’s permission. Third, move more after surgery, if you can’t get out of bed to move in bed, such as turning over, moving limbs, etc., physical strength allows you to move out of bed. Fourthly, rest and sleep in the slope position, not lying down.
10.What about wound pain?
There are usually analgesic pumps after surgery, which can reduce the pain. If the pain is unbearable, you can tell the doctor, who will give the appropriate treatment according to the situation.
11.When can I get off the floor?
If your physical strength allows, you can leave the bed as soon as possible, you can move around the bedside first, and then move around the ward.
12.When will the urinary catheter be removed?
Usually the urinary catheter can be removed 2-3 days after surgery. If there is an epidural pump, prostate enlargement and the need to record the in and out volume, it may be necessary to extend the duration of the indwelling urinary catheter.
13.When should the chest tube be removed?
The doctor’s comprehensive judgment of the condition is needed to decide the specific timing of removal.
14.When to remove the gastric tube?
The doctor needs to make a comprehensive judgment on the condition to decide the specific time to remove the tube.
15.When can the stitches be removed?
If the wound heals well, the stitches are usually removed about a week after surgery.
16.When can I eat?
Usually a barium swallow film is taken 1 week after surgery to understand the anastomosis condition. If the anastomosis is healing well, you can start eating.
17.When can I leave the hospital?
You can be discharged after 1-3 days of eating without any discomfort.
18.What should I pay attention to when I eat?
Initially, if you do not choke on water when eating, you can eat semi-liquid food for 1 week, and then eat normal meal after 1 week. If there is water choking, you need to eat rice paste to exercise the swallowing function, and after the swallowing function is coordinated, you can eat normal food. After surgery, you should eat regularly and quantitatively, usually 5-6 meals, with activities after meals, and do not eat 1-2 hours before bedtime. Avoid eating large pieces of fatty meat to avoid blocking the anastomosis. Monitor weight regularly to avoid weight loss.
19.Can I sleep flat on my back after surgery?
You should not lie flat, but sleep in slope position above 30 degrees to reduce reflux and misaspiration.
20.Is it cured after the surgery?
For early stage esophageal cancer, surgery can cure it; for middle and late stage esophageal cancer, surgery alone is not enough, but preoperative radiotherapy or postoperative chemotherapy is needed. However, both early-stage and mid-stage esophageal cancer have the risk of recurrence and metastasis. This requires patients to come back for regular review after discharge, so that recurrence and metastasis can be detected in time and treated as early as possible.
21.How long can I live?
The pathological results after surgery can accurately evaluate the severity of esophageal cancer. The less severe it is, the longer the life expectancy. From the data of our hospital, the 5-year survival rate of all operable patients is around 40%.
22.When should I come back for review?
First review within 2-4 weeks after discharge from the hospital. The review will be every 3 months for 1 year after surgery, once every 6 months for 2-3 years, and once a year after 3 years.
23.What will be checked during the review?
Physical examination, blood sampling (routine blood, biochemistry, tumor markers, etc.), X-ray (chest film + barium swallow), cervical and abdominal ultrasound, chest and abdominal CT and endoscopy (CT and endoscopy once every 6-12 months) are required.
?
24.What should I do if I always have acid reflux after discharge?
Acid reflux is easy to occur after surgery, especially when sleeping. First of all, you should pay attention to whether the slope lying angle is not enough when you sleep. If you still have acid reflux even after increasing the slope angle, you need to consult an outpatient clinic and take medication.
25.What happened after discharge from the hospital that I could not swallow slowly?
The recurrence of dysphagia after discharge suggests anastomotic stenosis, which may be caused by anastomotic scar stenosis or by recurrence of anastomotic tumor. Outpatient consultation is needed for further examination.