Poll: esophagectomy patients

nurseabc123 · Sep 19, 2008

Just kinda taking an informal poll from other cardio-thoracic/SICU nurses...
Does anyone else think that the majority of post esophajectomy patients do rather poorly post op?
My hospital has had at least half a dozen so far this year, and I cannot recall one that hasnt had some unexpected complication. It seems to me that their quality of life after this major surgery isnt much better. All of ours have essentially turned into long term care patients, with trach's, tube feeds, infections, etc. They all have other major co-mobidities to start with too.
I dont know... just seems like its a trend. When ever we get one of these patients, we are all like "oh no, not another one. They are going to be worse off after surgery." Kinda like our fresh lung transplant patients...seems as if only a few do really well.
Anyway, just was wondering if others are seeing this.

I can think of one recent case. Esophogectomy that stopped taking his plavix/asa one week prior to surgery had an anterior infarct immediately post-op. IABP was emergently placed and started on CRRT within 24 hours. Struggled to keep pressures > 50. A few mini codes here and there and severely acidotic, the family finally withdrew less than 48 hours post-op. Other than that, no other cases really come to mind.

Creamsoda, ASN, RN · Sep 19, 2008

Yes I agree..from what i see they do rather poorly. Last year we had quite a few, and they never did well. Often had long stays if they made it out of the ICU. There was only 1 pt, who actually did well...but he was youngerish...50's and he made himself a DNR which was smart, so that he never had to come back.

BellaCerraRN · Sep 23, 2008

I wanted to chime in on this thread as both a CCU nurse as well as the wife of a survivor of esophageal cancer/esophagectomy.

My husband was diagnosed very early and had his esophagectomy within days. He did remarkably well. Out of ICU in 3 days and home in 10. He went home with a peg tube and we used it 2 or 3 times. Because of my experience in home terminal care I was able to feed him orally right out of the gate while keeping his nutritional needs covered.

He did not suffer from any of the after effects that we were expecting. He does suffer a bit from dumping syndrome.

Because of all the research I did before the surgery I can assume that the reason so many esophagectomy patients fair so poorly is because of the stage of disease prior to the surgery and because nutritional needs cannot be met as fast as they need to be. Most people receiving an esophagectomy are already stage 4 esphageal cancer and esophagectomy is one of many last ditch efforts at providing palliative care, not cure. So they've got a disease process in which they are essentially wasting away already only to be compounded with a surgery that only compounds that as well.

Well, I'm off to take my husband to the Dr... as we are stage 4 palliative now....