The esophagus is a tubular organ, surrounded by muscles, located between the pharynx and the stomach. It provides the transmission of food taken from the mouth to the stomach. It is analyzed in 3 parts anatomically because it is located in the neck, thorax and abdomen.

Esophageal cancers arise from squamous cell carcinoma (squamous cell carcinoma) lining the interior of the organ. Cancer arising from secretory cells called adenocarcinoma can also be seen in the part close to the stomach. Esophageal cancers spread through lymph channels and lymph nodes, as the mass grows and spreads to the surrounding structures. The aim of surgical treatment in esophageal cancers is to remove the esophagus with clean borders from the surrounding tissues and without disturbing the integrity of the lymph nodes that are likely to spread.

HOW IS CANCER OF THE ESOPHAGUS DIAGNOSED?
The most common complaint is difficulty in swallowing. Weight loss in a short time (more than 10 kilos in 6 months) due to malnutrition is pain spreading to the back and chest. A mass can be suspected by taking a barium esophageal radiograph in the patient who presents with difficulty in swallowing. The definitive diagnosis is made by examining the esophagus and stomach with the help of an endoscope, seeing the mass and taking biopsy from the mass. Computed tomography is a valuable radiological examination in terms of both showing the course of the esophagus in the thoracic cage and the relationship of the mass with the surrounding organs (heart, respiratory tract and lung), as well as detecting the spread in distant organs (such as the liver).

TREATMENT OF ESOPHAGUS CANCERS
The current treatment option in esophageal cancers originating from the neck is radiotherapy (radiation therapy), and it gives results similar to the surgery applied, but also eliminates the risks and complications of surgery. In other esophageal sections, surgery is essential in the treatment. Chemotherapy (treatment with drugs) can be applied with radiotherapy, which reduces the preoperative mass and increases its operability. Again, oncological treatment is given to prevent recurrence of the disease after surgery.

Surgical treatment for esophageal cancers includes all 3 regions of the organ. The thorax is opened and the esophagus is carefully freed from the surrounding tissues, with clear boundaries. Lymph nodes around the esophagus and around the respiratory tract are also cleaned and removed. After this stage, it is passed to the abdominal region. As the esophagus opens into the stomach, the stomach is released and separated from the esophagus. The lymph nodes around the stomach, which is the second way of spreading cancer, are also cleaned and removed. After the esophagus is removed, a part of the stomach or large intestine is prepared according to the surgeon’s preference in order to make a new esophagus. In the third stage of the operation, the pharynx and esophagus are cut in the neck area, the esophagus is completely taken out of the body, and the stomach or large intestine prepared in the abdomen is pulled to the neck area and connected to the pharynx.

The close anatomical relationship of the esophagus with the main vascular structures, respiratory tracts and heart in the thorax; the need to clean the lymph nodes around the stomach and make a new esophagus; Since this new esophagus is brought to the neck and reconnected with the mouth, surgery for esophageal cancers is a very heavy operation and requires serious experience.

WHO CAN SURGERY BE USED?
Esophageal cancers are a group of diseases in which a very long life expectancy is not expected if left untreated. The mass should be evaluated with computed tomography before the operation. In the presence of spread to vital organs or detection of spread to distant organs such as the liver, surgery is postponed and oncological treatment is applied first. In addition, a very valuable test called PET/CT is performed preoperatively to detect the spread of disease in a small size that computed tomography cannot show. It is a test used in the follow-up of the disease in the postoperative period.

Malnutrition and weight loss are the main findings in esophageal cancers. Nutritional status of patients should be evaluated before surgery. It is very important for this patient to be able to undergo surgery, for good postoperative wound healing. Eating can be facilitated by placing a stent into the mass with the help of an endoscope in order to increase the physical condition of the patients by feeding. Especially before oncological treatment, a tube is inserted into the stomach or small intestines, and nutrition is provided through this tube. Intravenous feeding by placing a cannula into the vein is another alternative for recovery in a short time.

WHAT AWAITS YOU AFTER THE SURGERY?
Opening the thoracic cage during surgery can cause problems in the postoperative period. Problems ranging from difficulty in breathing to severe pneumonia can be seen and can become life-threatening. Although leaks and fistulas can be seen in the applied sutures, their incidence is very low with the quality of the surgical technique applied and the improvement of the patient’s nutritional status. These leaks can become life-threatening. After esophageal cancer surgery, patients can eat as before. Less frequently, strictures may develop in the newly formed esophagus. These strictures can be expanded with the help of endoscopy. Although the need for reoperation is very rare, it is possible.