PHARYNGO-OESOPHAGECTOMY
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1 PHARYNGO-OESOPHAGECTOMY This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu and yur cancer care team. AN OVERVIEW TO PHARYNGO-OESOPHAGECTOMY The pharynx is the tube that cnnects the nse and muth t the tp f the windpipe and esphagus. It is better knwn as the thrat. The esphagus is the tube that cnnect the pharynx t the stmach. A pharyng-esphagectmy is an peratin t remve cancer lcated in the lwer thrat (hyppharynx) and the tp part f the esphagus (see picture belw). This is a cmplex peratin and usually includes remval f the vice bx (larynx). Since the vice bx has been remved, yu will breathe thrugh a hle in the thrat, called a trachestma. There may be several surgens invlved in yur peratin. 1
2 After the cancer is remved: recnstructive surgery is usually dne and may use flaps frm the bwel r pull-up f the stmach lymph ndes may als be remved frm the neck. Visit the Beynd Five website fr further infrmatin n hyppharyngeal cancer, recnstructive surgeries, and n any ther surgeries yu may be having fr yur particular cancer, such as neck dissectin r laryngectmy. WHY IS A PHARYNGO-OESOPHAGECTOMY NEEDED A pharyng-esphagectmy is recmmended fr sme large cancers that extend frm hyppharynx t the esphagus. It is ften used fr hyppharyngeal cancers that have cme back after raditherapy r are nt suitable fr raditherapy. The cancer tgether with an area f nrmal-appearing tissue is remved, t reduce the chance f any cancer cells being left behind. The tissue remved will be examined in detail by a specialist pathlgist, under a micrscpe t lk fr cancer cells. Thrugh this examinatin, the cancer can be accurately staged. Further infrmatin abut staging f cancer is available n the Beynd Five website. 2
3 HOW TO PREPARE FOR THE OPERATION Befre the peratin: Yu will need t fast (have nthing t eat r drink) fr 6 hurs befre yur peratin (unless advised differently by yur surgen r anesthetist) because the pharyng-esphagectmy is perfrmed under a general anaesthetic (yu will be asleep and will nt remember what happens during the peratin). Yur surgen will explain the details f yur peratin. Be sure t bring up any questins r cncerns, and share yur needs and wishes with yur cancer care team (see bx). Yu shuld speak t yur dctr abut hw t manage aspects f yur lifestyle, such as smking, drinking alchl and chrnic cnditins (e.g. diabetes and besity) that may increase the risk f cmplicatins. If yu take bld thinning medicatin fr a heart cnditin r bld clts (such as warfarin, Plavix, aspirin r Pradaxa), make sure yur surgen is aware. Sme f these medicatins need t be stpped mre than a week befre the peratin. Smetimes a shrt-acting bld thinner (such as Clexane) is used befre and after the surgery. Talk t yur surgen and cancer care team abut any likely side effects yu can expect fllwing the peratin. Pssible questins that yu may want t ask yur cancer care team Will I be able t swallw after surgery? Hw lng until I can expect t swallw? What type f fd will I be able t eat? If I can't swallw, hw will I be fed? Hw will I be able t cmmunicate afterwards? Will I be able t speak again? Hw will I be able t speak? Additinal questins are listed at the end f this factsheet. A pharyng-esphagectmy will permanently and significantly alter yur speech and swallwing functin. It is imprtant t talk t a speech pathlgist abut what t expect after peratin and hw yu might be helped t speak and swallw afterwards. A dietitian may als be useful t discuss issues abut eating. Yur speech pathlgist may arrange fr yu t meet anther patient wh had this peratin (either nline r in persn). It can help t hear hw they have cped and adjusted; it may als be encuraging t hear hw thers have managed t recver well. Yur cancer care team can assist with making these cntacts. 3
4 Spend sme time planning hw t cmmunicate with peple including the nursing staff straight after the peratin as yu may nt be able t talk. It may be useful t have a tablet/prtable device r pen and paper t write dwn what yu want t say. Visit the Beynd Five website fr further infrmatin n health prfessinals wh may be part f yur cancer care team WHAT TO EXPECT DURING THE OPERATION During a pharyng-esphagectmy: A cut is made in the centre f the neck, extending far acrss each side f the neck. A cut is als made in the upper part f the belly (abdmen). The pharynx and vice bx are remved thrugh the cut in the neck and the esphagus is remved thrugh the cut in the abdmen. Lymph ndes in yur neck may als be remved at the same time. This is called a neck dissectin. Further infrmatin n neck dissectin is available n the Beynd Five website. Part f the thyrid gland is als ften remved. Recnstructin: After the pharynx and esphagus has been remved there will n lnger be a cnnectin between the muth and the stmach. This is usually recnstructed by bringing the stmach up thrugh the chest and jined t the back f the tngue. This is called a gastric pull-up. The tp f the windpipe will be jined t a hle made in the frnt f yur neck, called a trachestma. There will n lnger be a cnnectin between the muth and windpipe. Instead, there will be a hle in the neck t allw fr breathing. This is a permanent change. There will be a feeding tube inserted thrugh the nse r directly int the bwel t prvide nutritin int the bdy fr the first week r tw after surgery, r smetimes lnger. Further infrmatin abut feeding tubes is available n the Beynd Five website. 4
5 WHAT TO EXPECT AFTER THE OPERATION After the peratin, yu will be clsely mnitred in either a ward bed r the intensive care in the hspital during yur recvery. Yu will have sme surgical drains cming frm the area f the peratin t allw bld r fluid t escape and prevent swelling. These will be remved befre yu g hme. Yur anesthetist and surgical team will give yu medicine t help cntrl any pain and nausea after the peratin. Yu will have a drip in yur arm t give yu fluid and a feeding tube t keep yur bdy healthy and prmte healing until yu are able t eat and drink by muth. The peratin takes several hurs, s a catheter is usually placed in the bladder t mnitr hw yur kidneys are wrking. Yu will breathe thrugh the breathing hle in yur neck (stma), and will n lnger be able t speak nrmally. A trachestmy tube is usually placed in the hle t start with. This tube will need t be suctined and cleaned by the nurse lking after yu. It is cmmn t wait abut ne week befre starting t eat. This will give time fr the recnstructin create a strng seal s fd des nt leak ut. A speech pathlgist will help yu with vice rehabilitatin that may invlve speaking by: using an artificial larynx with an electrnic device (electrlarynx) using a value in the hle in yur thrat s that air frm the lungs can reach the fd pipe (trache-esphageal speech). Once the feeding tube is remved, yu may have difficulty with yur swallwing functin. A speech pathlgist may be invlved in yur recvery t help with this. Sme patients may g hme with a feeding tube. Mst patients stay in hspital fr arund 2 3 weeks t recver, but will vary depending n hw yu recver. 5
6 POSSIBLE RISKS OF PHARYNGO-OESOPHAGECTOMY All peratins carry sme risks such as bld clts, wund infectins, bleeding, chest infectin, adverse reactins t anaesthetic, and ther cmplicatins. These risks will be explained by yur cancer specialist and anaesthetist. Yur dctr will explain details f the peratin, general risks and side effects f the peratin, they may recmmend: stpping bld thinners (e.g. aspirin) befre surgery t reduce the risk f bleeding a bld thinner (called heparin) may be injected befre and after surgery t reduce the risk f bld clts antibitics t reduce t risk f wund infectin early mbilisatin t reduce the risk f bld clts and chest infectin special stckings t reduce the risk f bld clts. A pharyng-esphagectmy is a very big peratin and it may take a lng time t recver. Pssible risks f this surgery include: Leakage f saliva (fistula): If the recnstructin leaks, saliva and fd will cllect under the skin and cause an infectin. This can be a very serius cmplicatin and might require pening the wund t allw it t drain r return t the perating rm t fix the seal. Smetimes this is because there is nt enugh bld supply t the stmach that has been pulled up. This will cause the tissue t die and further majr surgery may be needed t replace this tissue. Infectin: The thrat has lts f bacteria. These bacteria can cause an infectin in the neck wund after the surgery. Antibitics are given during surgery and fr a day r s after, but infectins can still happen. This might require pening part f the wund t allw any pus t drain ut. Leakage f lymphatic fluid (chyle leak): Lymphatic fluid leaks frm lymph channels (near where lymph ndes were remved) and may cause swelling under the skin. This can be treated using a special diet. 6
7 Lw bld calcium: The parathyrid glands (respnsible fr cntrlling the bdy s calcium levels) are lcated near the larynx and may be damaged r remved during the pharyngesphagectmy. This may cause bld calcium levels t fall belw nrmal, leading t muscles spasms and can be treated with calcium tablets. Bwel prblems: After majr abdminal surgery the gut may stp wrking fr sme time. This is called an ileus. Occasinally the bwel can be injured r twisted causing infectin r blckage that needs t be treated with mre surgery. SIDE EFFECTS AND THEIR MANAGEMENT As with all peratins, there is a chance that pharyng-esphagectmy may lead t a number f side effects. Yu may nt experience all f the side effects. Speak with yur dctr if yu have any questins r cncerns abut treatment side effects. Cmmn sides effects fr pharyngesphagectmy may include: Nausea: General anaesthetic may cause nausea. This will settle dwn sn after the peratin and can be treated with medicatins. Pain management: Pain is a cmmn side effect f the peratin. Yur anaesthetist will give yu pain medicine during the peratin t keep yu cmfrtable when yu wake up, and yu may cntinue n pain medicines t ensure pain is under cntrl. Changes in eating and speaking: Pharyng-esphagectmy will affect eating and speaking. Breathing and feeding tubes may be used t help breathing and receiving nutritin, especially sn after the peratin. It may be useful t have a tablet/prtable device r pen and paper t write dwn what yu want t say. The speech pathlgist and dietitian will prvide any assistance needed t help with yur speaking and eating during recvery. Changes in appearance: Yur appearance may change and it may be hard t accept. Seek supprt frm the cancer care team, family and friends. Cntacting ther patients may als assist. Hypthyridism: If all r sme f the thyrid gland is remved during the laryngpharyngectmy and nt enugh thyrid hrmne is made, sme peple may feel tired and sluggish. This is very cmmn if yu have already had raditherapy. Bld tests are used t measure the levels f thyrid hrmnes abut tw mnths after surgery. Yu may need t remind yur surgen r family dctr t check this. Thyrid hrmne can be replaced by a nce-daily pill. 7
8 Ask yur dctr r visit the Beynd Five website fr further infrmatin n side effects assciated with pharyngectmy and recnstructive surgeries, and n any ther surgeries yu may be having fr yur particular cancer BEFORE GOING HOME Yur recvery will depend n the type f peratin and yur general fitness befre the peratin. Smetimes peple may have a stay in a rehabilitatin r a skilled nursing facility befre ging hme. Any particular instructins fr wund care r medicatins will be prvided t yu befre yu g hme. The trachestma (hle in neck that yu breathe thrugh) needs special attentin. It is very imprtant t keep it clean and stp crusts frm building up. The nurses will teach yu hw t d this befre yu g hme. Yu may want t dwnlad further infrmatin abut wund care n the Beynd Five website. Yu will be assessed by the team invlved in yur care befre yu g hme and fllw-up will be arranged with yur surgen and GP. After a pharyng - esphagectmy, fllw-up will be arranged with a speech pathlgist and a dietitian: A speech pathlgist will assist yu t develp ther ways t speak withut a vice bx. A dietitian will help ensure yu get gd nutritin while yu are recvering and swallwing is difficult. Fllw-up may als be arranged with any ther allied health prfessinals t assist yu with supprtive care. Yur cancer care team can help yu make cntact with ther patients and supprt grups t hear hw they have cped and adjusted. Yur recvery at hme may vary and yu shuld allw time fr yur bdy t recver and heal. With majr surgery this can be slw and yu may feel tired r lack energy. Regular fllw up helps t assess yur prgress. 8
9 FOLLOW-UP CARE After a pharyng-esphagectmy, yu will cntinue t have regular fllw-up visits with yur specialist dctr and cancer care team. Onging referrals will als be arranged as required with ther health prfessinals, such as speech pathlgists and dietitians t assist with managing difficulties with eating and speaking. Any additinal recnstructin, csmetic prcedures r treatments that yu may need are planned after discharge. This enables time fr yu t recver frm the initial peratin, get results f the pathlgy that examined the tissue remved at the peratin, and make the arrangements fr any additinal treatment r next steps. Fr further infrmatin abut the peratin fr cancer and what t expect, yu can als refer t Understanding Surgery: a guide fr peple with cancer, their families and friends. 9
10 QUESTIONS TO ASK YOUR DOCTOR Is surgery the nly ptin culd I have raditherapy? What will happen if I dn t have the pharyng-esphagectmy? What type f recnstructin will I have and what are the side effects? Hw will I be fed whilst I'm recvering frm the peratin? Will I be able t eat in the lng-term after the peratin? Hw lng will it take t recver s that I can speak? What type f neck dissectin will be dne? Can yu explain what des this mean? What will happen if I dn't have the neck dissectin? What are the risks f neck dissectin? Hw lng will the peratin take? Hw lng will I be in hspital and hw lng d I need ff driving, wrk and exercise? What are the pssible side effects f neck dissectin? Hw can they be prevented r managed? Will I need any extra treatment? What lifestyle changes (diet, exercise) d yu recmmend I make? Hw much will the peratin cst? Will my health insurance cver it? Will I be able t lead a nrmal life? What fllw up tests will I need? If I wanted t get a secnd pinin, can yu prvide all my medical details? Yu may want t write additinal questins here t ask yur dctr r cancer care team Beynd Five disclaimer: Yu acknwledge and accept that the infrmatin in this factsheet is fr general infrmatin purpses nly. It is nt intended, nr shuld it be relied n, as medical r legal advice, r as a substitute fr cnsultatin with a physician r ther licensed healthcare prvider. Yu agree that if yu have individual healthcare-related questins yu shuld cntact yur dctr prmptly and shuld nt disregard prfessinal medical advice, r delay seeking it, because f infrmatin cntained here. Yu als agree that Beynd Five is nt liable fr any injury r damage t persns r prperty (hwsever caused, including by negligence) arising ut f r related t any use f Beynd Five s patient educatin materials, r fr any errrs r missins. Last Updated: 21 Octber
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