Esophagectomy treats conditions like esophageal cancer or severe damage. The difference between laparoscopic and open esophagectomy lies in the surgical approach—laparoscopic uses small incisions with a camera, while open involves a large incision in the chest or abdomen. This difference affects recovery time, complications, and expected results, helping patients choose the most suitable method with their medical team.
What is an esophagectomy?
Esophagectomy is a surgical procedure in which part of the esophagus or the entire esophagus is removed. This procedure may also involve removing part of the stomach or surrounding lymph nodes. The digestive tract is often reconstructed using part of the stomach or colon to connect it to the throat or pharynx:
- Esophageal cancer: Especially in stages where the tumor is still localized or resectable.
- Severe damage or scarring causing esophageal obstruction, due to one of the following
- Chronic gastroesophageal reflux disease (GERD)
- Severe thermal or chemical injury
- Advanced motility disorders, such as achalasia, if other treatments fail
The procedure is very complex and requires a specialized surgical team and is performed either by open surgery or using laparoscopic or robotic techniques, depending on the patient’s condition and the progression of the disease.
Laparoscopic esophagectomy: Overview
Laparoscopic esophagectomy is a surgical procedure that utilizes laparoscopic technology to remove part or all of the esophagus through small incisions, rather than traditional open surgery. In this procedure, a camera and precision instruments are inserted through these incisions, allowing the surgeon to visualize the tissue and perform the resection with high precision.
Laparoscopic Esophagectomy Steps
- General anesthesia: The patient undergoes general anesthesia to ensure no pain during the procedure.
- Small incisions in the chest and abdomen: Several small incisions (usually 5 to 6) are made to insert the laparoscope and instruments.
- Insertion of the scope and camera: A small camera with a light is inserted through one of the incisions to transmit a vivid and clear image.
- Resection of the damaged esophagus: The affected part of the esophagus is carefully separated while preserving important surrounding tissues.
- Removal of lymph nodes (if cancerous): Surrounding lymph nodes are removed to remove any possible cancer cells.
- Gastrointestinal reconstruction: The rest of the esophagus is connected to the stomach or part of the intestine using sutures or surgical staples.
- Close the incisions: Smaller incisions are sutured after making sure the procedure is safe.
Advantages of laparoscopic esophagectomy (modern technique)
- Less pain after the procedure compared to open surgery
- Smaller incisions lead to faster recovery and less scarring
- Reduced risk of infection and wound complications
- Reduced hospitalization time
- Higher accuracy in tissue resection due to the clarity of the magnified endoscopic image
This technique is an excellent and advanced option that offers significant benefits to patients compared to traditional methods, but requires a surgical team trained in the use of laparoscopy.
Open esophagectomy: Overview
Open esophagectomy is a traditional surgical procedure performed through large incisions in the chest and abdomen to remove part or all of the esophagus.
Open esophagectomy steps
The surgery is performed under general anesthesia and includes the following steps:
- Making a large incision in the chest to access the esophagus
- Making an incision in the abdomen to control the stomach or part of the intestine to reconstruct the digestive system
- Removing the affected part of the esophagus along with neighboring tissues
- Removing nearby lymph nodes in cancer
- Reconnecting the stomach or part of the intestine to the remaining esophagus or throat to restore digestive continuity
- Closing surgical incisions with sutures or staples
When is open surgery preferred?
- When the tumor is so large or widespread that laparoscopic removal is not possible
- If there are previous complications or scars that prevent the use of laparoscopic surgery
- When extensive tissue removal or complex reconstruction is needed, that cannot be achieved with less invasive methods
Difference between laparoscopic and open esophagectomy
Two main methods are used to perform esophagectomy: Laparoscopic (minimally invasive) and open surgery, which differ in many aspects of surgical technique, recovery time, risks, and cost, with very similar long-term outcomes with the right expertise.
Wound size and scarring
Laparoscopic esophagectomy
It is a minimally invasive surgery in which small incisions are made (usually between 4 to 6 incisions), through which the surgeon inserts precision instruments and a camera to view the organs and perform the operation without the need to cut muscles or remove ribs, and the laparoscope is used to access the organs through small entrances instead of incisions.
Open surgery
Open surgery involves making one or more large incisions in the neck, chest, or abdomen to provide a direct view of the esophagus.
Recovery time
Laparoscopic esophagectomy
Smaller incisions result in less pain after the procedure, faster recovery, and a shorter hospital stay.
Open surgery
After open surgery, the patient usually needs to stay in the hospital for one to two weeks, and full recovery may take 3 to 6 months, sometimes longer.
Risks and complications
Laparoscopic esophagectomy
Laparoscopic surgery minimizes the risk of bleeding and provides less exposure to internal organs, which reduces the risk of infection, and the scars are smaller.
Open surgery
Risks include: Respiratory complications such as pneumonia, bleeding, infection, leakage from the delivery area, cardiac disorders, and even death.
Long-term results
Studies show that long-term outcomes in terms of survival and quality of life after the procedure are similar for both methods, provided the procedure is performed at an experienced medical center.
Cost and equipment required
Laparoscopic esophagectomy
Laparoscopic surgery requires advanced equipment and a surgical team trained in the use of modern techniques, which may increase the cost or limit its availability in some hospitals.
Open surgery
The traditional method is the most commonly used, especially in hospitals that do not have an advanced laparoscopy team, in some centers open surgery remains the main option due to the lack of infrastructure for laparoscopic techniques.
Doctor’s opinion and optimal choice
Choosing the type of esophagectomy surgery, whether laparoscopic or open, is a complex decision that depends on several individual medical factors, including the stage of the disease, the location of the tumor, the general condition of the patient, the presence of comorbidities, and the availability of surgical expertise at the medical center. There is no one-size-fits-all approach, and the medical team thoroughly evaluates the case to determine the safest and most effective option.
Doctors emphasize that a frank conversation with your surgeon is crucial as it allows the patient to understand the benefits and risks of each surgical option, what to expect during the recovery period, and the chances of long-term recovery. This discussion helps in building a shared decision and makes the patient feel confident and comfortable with the proposed treatment plan.
Surgical advantages in Turkey
Turkey is one of the leading destinations for advanced surgeries such as esophagectomy, for several medical and technical reasons, including:
- High medical expertise: Specialized thoracic and upper gastrointestinal surgeons with international training and experience in open, laparoscopic, and robotic techniques.
- Availability of modern technologies: The use of laparoscopic and robotic surgery systems in a large number of university and private hospitals.
- Highly rated specialty centers: internationally accredited hospitals (such as JCI) that offer integrated treatment services in an advanced medical environment.
- Relatively low cost: Compared to European countries or the United States, the cost of the procedure (including surgery and accommodation) is much lower while maintaining the quality of treatment.
- High-quality post-operative care: Careful follow-up programs after discharge, including nutrition, rehabilitation, and surgical follow-up.
- The ability to combine treatment with temporary stabilization: Ease of obtaining a medical visa, and the possibility for the companion to stay with the patient in comfortable accommodations adjacent to the medical centers.
The difference between laparoscopic and open esophagectomy lies in choosing the most appropriate approach based on health status, disease stage, and surgical team expertise. Effective communication with the physician, understanding available options, and weighing benefits and risks are vital for success and optimal long-term outcomes. Selecting the right medical center with specialized care is key to treatment and recovery.
Sources:
- National Library of Medicine. (2023, January 23). Esophagectomy – open. MedlinePlus.
- Orringer, M. B., Marshall, B., & Iannettoni, M. D. (2001). Transhiatal esophagectomy: clinical experience and refinements. The Annals of Surgery, 234(3), 334-343.
