April 14, 2017
Surviving Esophagectomy Surgery
The first phase of my treatment for esophageal cancer required chemotherapy 24 hours a day, 5 days a week for 6 weeks, along with 28 simultaneous radiation treatments. Now I faced esophagectomy surgery to remove the tumor at the junction of my esophagus and stomach. But first, I needed 8 weeks of rest so that the radiation could get out of my system. My body needed to be in good condition for major surgery.
My mind was in total chaos. What would be the outcome? Would I beat this monster and survive, or would I be counting down the remaining days of my life? I was confident in my Memorial Sloan Kettering Cancer Center (MSKCC) team of doctors, but I knew the chances of surviving esophagectomy surgery were also dependent on me.
My surgery would be a 4- to 5-hour procedure. First, the surgeon would remove two-thirds of my esophagus and one-third of my stomach. Next, he would reattach the remainder of my stomach to what was left of my esophagus. In the end, the top of my stomach would be positioned in the middle of my chest.
The surgery required two large incisions, one running from my belly button to my chest bone; the second from under my right arm to the middle of my back. Although no bones would be broken during the surgery, one lung would be intentionally collapsed so the surgeon could reattach my stomach in its new location.
When I woke up in the recovery room, I had a gastric drainage tube coming out of my nose to keep my stomach clear of any matter. I also had chest tubes on each side of my body to keep my chest cavity free of fluids, as well as a urinary catheter. The plan was for me to stay the first night in the recovery room, then I would be transferred to the hospital’s thoracic floor for the remainder of my hospital stay.
Recovery: Week 1
Within 1 hour of arriving on the thoracic floor, the nurses had me up and walking. They informed me that 14 laps around the floor equaled one mile, and I was expected to walk that every day at a minimum. The nurses also gave me a breathing device called a spirometer, which measures how much air you inhale and exhale. Every hour I was expected to do 10 reps on the device to see how high I could get the indicator to rise. I’d received a spirometer before entering the hospital, so I knew my pre-surgical lung capacity. Now I placed the indicator at my previous highpoint and tried each day to see how close I could get. It was a work in progress.
In addition to walking and using the spirometer, I was asked to deliberately cough 10 times each hour. Although it sounds easy, it was the most difficult thing I had to do. When I coughed, my stomach vibrated, and the incision I had from my belly button to chest bone would jump with pain. I found that holding a pillow tight to my stomach suppressed some of the stomach vibrations and eased the pain.
For 7 days, I did not eat or drink anything.
Recovery: Week 2
After the first week, I underwent a barium swallow. This procedure showed if the surgical connection was healing properly. The test confirmed that I did not have any leaks at the new connection between my stomach and esophagus. These results meant that I could be freed from the tubes that were inserted during the surgery. What a relief it was to be rid of all that excess baggage. Walking around the floor was so much easier that I was able to do more than the minimum daily goal of 14 laps around the thoracic floor.
About a week after my surgery, I started on a liquid regimen. By the 8th day, I was promoted to a soft mechanical diet which included Jell-O, puddings, and even scrambled eggs, and within a day after that, I was eating off of the menu! This rapid progression from liquids to solid food is rare today, with new protocols keeping patients on a feeding tube or a soft mechanical diet for a longer period of time. But I was grateful to have made such rapid progress and leave the hospital on the 10th day.
When I came home after surgery, a new era of my life began.
Depression plays a role
After I was home, I found that depression was causing me to feel too tired to exercise. I would excuse myself by reasoning, “If I am tired now, how much more tired will I be after I exercise?”. As a result, I became a true couch potato. Because I had no appetite, I wasn’t eating properly and became focused on watching the clock.
I continued to lose weight. During my post-surgical check-up, the doctor saw that I was continuing to lose weight (from 250 pounds before the diagnosis to 170 pounds after the surgery.) He told me that if I lost another pound he was going to put a feeding tube in me. Well, that was the turning point of my esophagectomy recovery!
From that moment on, I began to take ownership of my health and the life in front of me. I began to exercise, which not only helped me heal quicker but also activated my appetite. My mental outlook also became more positive as I decided that I would live each day to the fullest.
Learning to eat a new way
Although my stomach was now smaller, I still needed the same number of calories to maintain my weight. Instead of the standard three meals a day, I ate six times daily. My stomach was smaller now so my new eating schedule included two breakfasts, two lunches, and two dinners. In time, I would regain some of the weight I had lost during the 7 months of chemotherapy, radiation, and surgery.
Sleep becomes a new experience
After surgery, I needed to sleep at a 30-degree angle so gravity would not move the contents of my stomach into my throat at night. I used a medical wedge pillow to ensure that my upper body was properly elevated.
The first 2 months of my recovery were definitely a challenging experience, but worth it. Learning new ways of eating, sleeping, and exercising proved to be the essential elements of my successful post-surgical recovery.
What esophageal cancer means for me
Esophageal cancer was a rude awakening for me and it helped me change my perspective on what life is all about. And, if there are positives that can come from having esophageal cancer, I am experiencing them. My wife, Ginny, and I have worked with MSKCC in their “Patient to Patient Program” and have supported more than 1,000 patients who have esophageal cancer. We also have formed the Esophageal Cancer Education Foundation (ECEF) to help make people more aware of this disease, support research projects that will lead to early detection, and walk the journey with patients and their families.
Read more about Bart’s journey.
Learn more about the Esophageal Cancer Education Foundation (ECEF) and the Esophagectomy Post-Surgical Guide: Questions and Answers.
Click here for more information about esophageal cancer.
The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.
The STS mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.