Surgery for oesophageal cancer

Different types of surgery can be used to treat oesophageal cancer. This will depend on the stage of the cancer.

  • Oesophagectomy – in this operation, the surgeon removes the part of the oesophagus that’s affected.
  • Oesophago-gastrectomy – this operation is used if the cancer is in the lower part of the oesophagus or if it has grown into the stomach. During the operation, the top of the stomach is removed with the lower end of the oesophagus.

The surgeon will also remove some of the nearby lymph nodes as some may contain cancer cells. This helps to reduce the risk of cancer coming back.

Sometimes it is possible to have keyhole surgery. This type of surgery involves a few small cuts rather than single larger cuts. The surgeon will use special instruments to see and work inside the chest and tummy.

Very early-stage oesophageal cancers can sometimes be removed using endoscopic mucosal resection (EMR). This may be followed by further treatment to make sure all cancerous cells have been destroyed.

How surgery is used

If the cancer is at an early stage, surgery may be used with the aim of curing the cancer. There are different types of operations used to treat oesophageal cancer. The operation you have will depend on the size and position of the tumour. You may need to stay in hospital for a few weeks for some types of surgery.

Your doctor will talk to you about the most appropriate type of surgery for your situation. It’s important to discuss the operation fully with your doctor before it happens. It may help to make a list of any questions you want to ask.

Types of surgery

There are two main types of operation:

Oesophagectomy

The part of the oesophagus containing the cancer is removed. The stomach is then pulled up and joined to the bottom of the oesophagus.

An oesophagectomy
An oesophagectomy

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Oesophago-gastrectomy

If the cancer is in the lower part of the oesophagus, or if it has grown into the stomach, you will need to have the top of your stomach removed along with the affected part of the oesophagus. The oesophagus and remaining stomach are then joined together.

An oesophago-gastrectomy
An oesophago-gastrectomy

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Rarely, the whole oesophagus needs to be removed (a total oesophagectomy). Your stomach will be pulled up into your chest to replace the removed oesophagus.

A total oesophagectomy
A total oesophagectomy

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Surgery to the lymph nodes

During your operation, the surgeon will check the area around the oesophagus. They will also remove some of the nearby lymph nodes. This is called a lymphadenectomy and is done because the nodes may contain cancer cells. The lymph nodes will be examined under a microscope by a pathologist. Removing them helps reduce the risk of the cancer coming back. It also helps the doctors find out the stage of your cancer.

How the operation is done

Depending on where the cancer is in the oesophagus, your surgeon will use one of these two main techniques:

  • Trans-thoracic oesophagectomy – Cuts are made in the tummy (abdomen) and chest so that the affected part of the oesophagus can be removed (known as a 2-stage oesophagectomy). Sometimes a third cut is also made in the neck (3-stage oesophagectomy).
  • Trans-hiatal oesophagectomy – Cuts are made in the tummy and neck to remove the affected part of the oesophagus.

After these operations, your stomach will be higher than it was before. It will be above, instead of below, the sheet of muscle (the diaphragm) that divides the chest from the tummy.

The stomach will also be smaller as it has been stretched to fill the space made by removing part of the oesophagus. This may affect your eating and drinking.

Sometimes it’s not possible to join your stomach to the remaining part of the oesophagus. In this case, a section of your large bowel (colon) will be used to replace part of the oesophagus. Your doctors will explain this in more detail if they think this type of surgery may be used.

Sometimes during the operation, the surgeon discovers that the tumour can’t be removed. This may be because the tumour has spread or gone through the wall of the oesophagus, or because many lymph nodes are affected. If this happens, the surgeon may insert a tube (stent) instead. This is to make eating and swallowing easier for you.

Keyhole surgery

Some people may be able to have either part, or all, of their operation by keyhole surgery (also called minimally invasive surgery). Your surgeon can tell you whether it’s suitable for you. In this operation, only small cuts are used rather than single larger cuts. The surgeon uses a special instrument called a thoracoscope to see and work inside the chest. A laparoscope is used for the inside of the tummy.

Sometimes during the operation, the surgeon decides that keyhole surgery is not suitable and will carry out standard surgery instead. Keyhole surgery should only be carried out by experienced and specially trained surgical teams.


Endoscopic mucosal resection (EMR)

Very early-stage oesophageal cancers that are just in the inner lining of the oesophagus (the mucosa), can sometimes be treated using endoscopic mucosal resection (EMR). For this procedure, an endoscopy is carried out. This is so the doctor can see the abnormal area clearly.

The cancer is then raised from the muscle layer of the oesophagus so it can be removed. This is done by either injecting fluid into the layer of cells below the cancer, or by using gentle suction. Your specialist will explain how they do EMR.

The most common side effects of EMR are bleeding and narrowing of the oesophagus. There is a very small risk of a tear in the wall of the oesophagus (called a perforation).

Your doctor may recommend further treatment after EMR, to destroy any cancer cells that might be left. Treatments that may be used in this situation are radiofrequency ablation (RFA), photodynamic therapy (PDT) and argon plasma coagulation (APC).

Back to Surgery explained

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

What happens after surgery?

You’ll be monitored closely after surgery. You will be given fluids through a drip until you can start drinking again, and painkillers to keep you comfortable.