Esophageal Cancer Resection, Abroad

Esophageal cancer surgery cost:
{the cost covers all destination medical & logistics costs}
International Destinations: India, Jordan, Mexico, South Korea, Turkey

Esophageal resection is the medical term for the complete surgical removal of the esophagus along with some of the surrounding lymph nodes. The esophagus is a hollow tube which allows the passage of food and liquids from the oral cavity to the stomach (i.e. it is the food pipe). After the resection of the esophagus, a surgical correction is done to allow the passage of food and liquids from the oral cavity to the stomach. Esophageal resection is done primarily for cancers affecting the esophagus or the upper part of the stomach. Medical tourism sites for conducting esophageal resection include, Mexico in North America, Jordan and Turkey in West Asia, India in South East Asia and North Korea in East Asia. These countries offer low cost and effective medical and surgical care.

When is Esophageal Resection Done?

Removal of the esophagus is done mostly for the following conditions,

• Esophagectomy is done for treatment of early stages of esophageal carcinomas before metastasis takes place. Annually in the United States of America, 13000 people are diagnosed with the condition. About 1.5% of all deaths due to cancer are attributed to this condition.
• Esophageal resection is conducted also for a pre-cancerous condition of esophageal mucosal lining (i.e. dysplasia) referred to as Barrett’s esophagus.
• In advanced cancers of the liver, stomach or the brain, where metastasis spreads to the esophagus. The principal objective is to relive pain during swallowing, which is caused due to undue pressure on the food pipe by the enlarging tumor.

Predisposing or risk factors for esophageal cancer:

The risk factors for esophageal cancer include:

• Consumption of tobacco, both chewing and smoking.
• Excessive consumption of alcohol. The combination of alcohol and smoking attribute to the highest risk of developing esophageal cancers in the United States.
• Long term acid reflux disease results in the development of pre cancerous condition of the esophageal lining ( i.e. Barrett’s esophagus)
• A low fiber diet, vitamin and mineral deficiencies, along with the deficiencies of micronutrients like zinc and riboflavin step up the risk.
• This condition also develops among people suffering from tylosis, (i.e. excessive layers of skin growth on the hand and feet). This is a genetic condition which is invariably associated with esophageal cancers.
• Other rare conditions include esophageal webs and achalsia ( a condition where the functioning of the esophageal sphincter is impaired)

Esophageal resection procedure:

There are numerous surgical approaches which are used to conduct the surgery, which depends on factors like the extent of involvement of the stomach and other tissues, and the medical condition of the patient.
Broadly there are two fundamental procedures involved,

• Esophagectomy: This procedure involves the removal of the esophagus and the surrounding lymph nodes. The procedure is conducted under general anesthesia and takes approximately six to seven hours.
  • Standard Open Esophagectomy: The procedure may be conducted via an incision made in the thorax or abdomen. The surgeon will gain access to the thorax and excise the tumor along with the surrounding lymph nodes. The remaining ends are reconnected.
  • Laparoscopic Esophagectomy: An alternative to the conventional procedure, this technique is less invasive and the surgeon gains access through several small multiple incisions. In this case, the abdomen is inflated with gas, to improve the visibility of the tumor. This procedure is conducted with the help of a camera attached to the laparoscope and video monitor that facilitates the entire surgery.
  • Vagal Sparing Esophagectomy: This procedure can be conducted by any of the above methods. However, this procedure mandates the need to preserve the vagal nerve plexus, which considerably reduces the chances of alteration of nerve functions like digestion and acid secretion.
• Esophagogastrectomy: A more intense surgery conducted under general anesthesia, it involves the removal of the lower portion of the esophagus along with the upper part of the stomach and the surrounding lymph nodes.Once the diagnosis has been confirmed, a PET scan is done to ascertain whether the cancer is localized or generalized, and whether it will respond well to surgery or not.
  • Similar to the two methods described above, esophago-gastrectomy can also be conducted through the conventional technique or through minimal invasive surgery, where the surgeon is guided by a laparoscopic camera and a video monitor. The latter is a less invasive procedure.
  • After the resection is done, the remaining portion of the stomach is pulled upwards and is connected to the upper part of the esophagus. This process is referred to as anastomosis. The alternative technique of anastomosis is when a piece of the colon is used to construct a new esophagus to connect the two ends.

The resection of the esophagus is often performed along with chemotherapy, which may be given preoperatively or post operatively, depending upon the patient’s condition.

Preparing for Esophageal resection:

• After a thorough medical history review and physical examination, the patient may be subjected to esophagoscopy, a procedure which allows the surgeon to examine the inside of the esophagus through a scope.
• Alternatively, a barium swallow (i.e. an X-ray test) is also used as a screening test, which allows viewing of the tumor mass using radioactive food, ingested by the patient.
• Other screening tests include CT Scan or Positron Emission Tomography (PET Scan)
• Once the diagnosis is confirmed, the procedure is scheduled
• Prior to the procedure, the patient is adequately covered by intravenous antibiotics to prevent the occurrence of infections
• The patient is given sedatives prior to being taken to the procedure room, after which general anesthesia is induced in the operating room

Post operative Care after esophageal resection:

• Immediately after the procedure the patient is critically monitored for about two days. The patient remains hospitalized for approximately two weeks ( if no complications arise) before he is discharged for home
• Pain medications and antibiotic cover is provided to the patients to relive pain and avert infections
• A naso-gastric tube along with a chest tube is inserted in the chest. The naso-gastric tube drains allows draining of stomach secretions and also allows the stomach to be washed and rinsed regularly. The tube is also used to feed the patient, until the patient completely recovers and is able to swallow food and drinks.
• A repeat barium swallow is conducted to assess the patient’s condition and identify any leakages. The patient is discharged only after all the tests confirm a normal healing process
• After being discharged, the patient is recommended to undertake gentle physical exercise. The wound dressing is kept clean and dry to encourage rapid healing.
• The diet of the patient primarily comprises of liquids and soft foods for almost a month after the surgery. The intake should be small quantities at frequent intervals.
• Regular medical check up and diagnostics are conducted to review the progress of the patient.

Complications of Esophageal resection:

• The most common complication is leakage from the site of anastomosis, where the sutures are stitched. The frequency of these complications is about 9%.
• Formation of blood clots
• Nerve injury
• Infection
• Breathing difficulties and pneumonia

Management of Esophageal resection in South Korea

South Korean hospitals have evolved and gained immense reputation internationally for their ability to manage patients and provide high quality of care, especially in the domain of surgical oncology. The country provides latest technological support for the management of cancers at internationally comparable prices.

Management of Esophageal resection in India

India’s evolution as a centre for medical tourism is attributed to its large manpower resource, which is technically qualified and cheaper than international resources. India has rapidly upgraded its physical infrastructure over the past decade, thanks to phenomenal growth rates. India provides the advantage of comprehensive services in oncology care at affordable prices.

Management of Esophageal resection in Mexico

Mexico is one medical tourism destination that is extremely close to the United States compared to the other medical tourism destination. The reduced travel time and cultural acquaintance makes Mexico the most preferred destination for oncology care.

Management of Esophageal resection in Jordan

Highly trained and qualified manpower coupled with the availability of latest technological advances makes the country one of the fastest growing medical tourism destinations. Located in West Asia, the country is closer to the United States compared to other eastern countries.

Management of Esophageal resection in Turkey

Turkey with the advantage of its low cost of medical care is a booming medical care destination. The healthcare infrastructure in the country is comparable to international standards and is constantly being upgraded.

Resources:

Cyberknife in India
Cyberknife at Anadolu Medical Center, Turkey
Chemotherapy Treatment (CHOP) Abroad
RCHOP Chemotherapy
Cyberknife Cancer Radiotherapy Overseas Radical Gastrectomy Surgery Abroad
Mastectomy Surgery Abroad
Total Pelvic Exenteration Abroad
Cervical Cancer Treatment Abroad
Laryngopharyngectomy With Plastic Reconstruction Abroad
Oral Cavity Cancer Treatment Abroad 
Bone Marrow Transplant Abroad

Medical Tourism Corporation facilitates esophageal cancer treatment in Europe, India and other overseas world-class oncology treatment destinations.