The main operation used to treat oesophageal cancer is called an oesophagectomy. In this operation, the part of the oesophagus containing the cancer is removed.

What is an oesophagectomy?

If the cancer is at an early stage, you may have surgery with the aim of curing the cancer.

The main operation used to treat oesophageal cancer is called an oesophagectomy. In this operation, the part of the oesophagus containing the cancer is removed.

The part that is removed depends on the size and position of the cancer inside the oesophagus.

  • If the cancer is in the lower part of the oesophagus or has grown into the stomach

    The surgeon removes the top of the stomach and the affected part of the oesophagus. They then join together the remaining parts of the oesophagus and stomach.

  • If the cancer is in the upper or middle part of the oesophagus

    The surgeon removes this part of the oesophagus. They then pull up the stomach and join it to the remaining part of the oesophagus.

Oesophagectomy

You may need to stay in hospital for a few weeks after surgery to the oesophagus.

Your cancer doctor will talk with you about the operation you are going to have. It is important to discuss the operation with them before it happens. It may help to make a list of questions you want to ask.

Surgery to the lymph nodes

During the oesophagectomy the surgeon removes a small area of healthy tissue around the oesophagus. This is called a margin. They also remove some of the nearby lymph nodes within the margin. This is called a lymphadenectomy.

A doctor who specialises in studying cells (pathologist) then looks at the lymph nodes under a microscope. This is to see if there are any cancer cells.

Removing the lymph nodes helps reduce the risk of the cancer coming back. It also helps the doctors know more about the stage of the cancer.

Having an oesophagectomy

Depending on where the cancer is in the oesophagus, there are two main ways the surgeon can do your operation:

  • Trans-thoracic oesophagectomy

    The surgeon makes cuts in the tummy (abdomen) and chest to remove the part of the oesophagus that contains the cancer. This is also called a two-stage oesophagectomy. Sometimes they also make a cut in the neck, which is called a three-stage oesophagectomy.

  • Trans-hiatal oesophagectomy

    The surgeon makes cuts in the tummy and neck to remove the part of the oesophagus that contains the cancer.

After an oesophagectomy, the stomach will be in a higher position in the body than it was before. It will be above, instead of below, the sheet of muscle (diaphragm) that divides the chest from the tummy. The stomach will also be smaller. This is because the surgeon has shaped it into a tube to replace the part of the oesophagus they removed. This will affect eating and drinking.

Sometimes, it is not possible to join the stomach to the remaining part of the oesophagus. In this case, the surgeon uses a part of the large bowel (colon) to replace the part of the oesophagus they removed. Your cancer doctor will explain this in more detail if they think they might use this type of surgery.

Sometimes during the operation, the surgeon finds that the tumour cannot be removed. This may be because the tumour has spread or gone through the wall of the oesophagus to nearby parts of the body. If this happens, your cancer doctor will talk to you about other treatment options.

Minimally invasive surgery (keyhole surgery)

The surgeon does this operation through a few small cuts in the tummy (abdomen), rather than one large opening. It is sometimes called keyhole surgery. The surgeon puts fine tubes with a camera and light on the end through the cuts. This lets them see and work inside the body.

If the surgeon does this surgery inside the chest to reach the oesophagus, this is called a thoracoscopy. If the surgeon does the surgery inside the tummy, it is called a laparoscopy.

You may be able to have part, or all, of your operation by keyhole surgery. Your surgeon can tell you whether this is suitable for you.

During the operation, the surgeon may decide keyhole surgery is not suitable. They will then do standard surgery instead. Keyhole surgery should only be done by experienced and specially trained surgical teams.

Possible risks of surgery

Your surgeon will explain the possible risks of oesophagectomy before you have the operation. You will have tests to check your heart and lungs, to make sure you are well enough to have it.

Some of the possible complications of surgery to the oesophagus may be life-threatening. You might need to stay in the intensive care unit for a while after surgery. Other possible risks include:

  • the join between the oesophagus and stomach leaking
  • a chest infection or pneumonia
  • bleeding
  • problems with the wound healing properly.

It is important to have the information you need about any possible risks before the operation. You can talk to your surgeon or specialist nurse if you have questions.

You will be in hospital for a few weeks with this type of operation. At first it may feel like you are improving quite quickly. But it may take a few months before you recover and can go back to your normal activities.

We have more information about having surgery for oesophageal cancer.

Before your operation

Before your operation, you will have tests to make sure you are well enough. These are usually done a few weeks before surgery at a pre-assessment clinic. They include tests on the heart and lungs.

Your surgeon and a specialist nurse will talk to you about the operation. You may see the doctor who gives you the anaesthetic (anaesthetist) when you are at a clinic or when you go into hospital for the operation.

If you think you might need help when you go home after your operation, tell your specialist nurse as soon as possible. For example, tell them if you might need help because you live alone or are a carer for someone else. Your healthcare team can help organise support before you go home.

You will usually go into hospital on the morning of your operation. Or you may go in the night before.

The nurses give you special elastic stockings (TED stockings) to wear during and after the operation. These help prevent blood clots in your legs.

Before surgery, it is important to make sure you have all the information you need. The operation can be complex so it is fine to ask lots of questions. Talk to your surgeon or specialist nurse if there is anything you do not understand.

Enhanced recovery programme

Many hospitals now have enhanced recovery programmes. This aims to reduce your time in hospital and speed up your recovery. It also involves you more in your own care. For example, you are given information about exercises you can do to help you get fitter before surgery, as well as exercises to do after your operation.

It also makes sure any arrangements needed for your return home are organised in advance.

Your cancer doctor will tell you if an enhanced recovery programme is suitable for you.

After your operation

You will probably be cared for in the intensive care unit, or a high-dependency unit, for a few days after your operation. You may be kept asleep for longer using a machine called a ventilator. This is to help your heart and lungs recover after the operation. If you are woken up earlier, a ventilator may be used to help you to breathe for a few hours. You will probably feel quite tired, and may not remember much about the first day or two after your operation.

Drips and drains

You may have some drips and drains attached to your body for a few days after surgery. These include the following:

  • A central venous catheter (CVC or central line)

    A CVC is a thin, flexible tube that is put into a large vein in the neck, upper chest or groin. It can stay in place for up to a week. It is used to give you fluids and medicines until you can eat and drink again. It can also be used to take blood samples without using a needle.

  • A naso-gastric tube

    A naso-gastric tube is a fine tube that goes up the nose and down into the stomach or small intestine. It drains fluid, so you do not feel sick.

  • Chest drains

    Chest drains are tubes put into the chest during the operation. They drain away any fluid that may have collected around the lungs. The fluid drains into a bottle. Tell your cancer doctor or a nurse if it is uncomfortable.

  • A feeding tube (jejunostomy)

    A feeding tube is a thin, flexible tube that goes into the small bowel through a small cut in the abdomen. It is used to give you food and nutrients until you can eat again.

  • Abdominal drain

    An abdominal drain is a tube that is put into the abdomen to help drain fluid and prevent swelling.

  • Urinary catheter

    A urinary catheter is a tube that is put into the bladder to drain urine into a collecting bag. It can be removed as soon as you can get up and walk around.

Reducing the risk of complications

The nurses will encourage you to get out of bed and move around as soon as possible. This helps reduce the risk of complications after surgery, such as blood clots and infections. The nurses can help you manage your drips and drains while walking.

A physiotherapist or nurse will teach you deep breathing exercises to help keep your lungs clear. They will also show you how to do regular leg movements to prevent blood clots forming in your legs.

A physiotherapist can also show you how to clear your lungs of any fluid that may have built up because of your operation.

Pain

You will probably have some pain and discomfort after the operation. Your cancer doctor or specialist nurse will explain how your pain will be controlled.

You may have painkillers in one of the following ways:

  • Into the space around the spinal cord (epidural)

    The painkillers are given through a very fine tube that the surgeon places into your back during surgery. The tube connects to a pump, which gives you a continuous dose of painkillers.

  • Patient-controlled analgesia (PCA)

    A painkiller is given through a pump that you control. This allows you to give yourself an extra dose of pain relief when you need it.

When you no longer need the epidural or PCA, you have painkillers as tablets or liquids.

It is important to tell your healthcare team if you are still in pain. Mild discomfort or pain in your chest can last for several weeks, so they will give you some painkillers to take home with you.

Your wound

You will probably have a dressing covering your wound, which might not be removed for the first few days.

How long the wound takes to heal depends on the operation you had. The surgeon may have closed your wound with glue or stitches that dissolve and do not need to be removed. If you do not have stitches that dissolve, they are usually removed about 7 to 10 days after your operation.

Tell a nurse or your cancer doctor straight away if your wound becomes:

  • hot
  • painful
  • leaks any fluid.

Eating and drinking after surgery

You will not usually have anything to eat for the first 48 hours after surgery. When you are fully awake, you may have small sips of clear fluids. The amount of fluids you have is slowly increased. After a few days, when you can drink enough, you will start having small amounts of soft foods, and then normal food in smaller portions. This gives the new joins made during surgery some time to heal.

Feeding tube

You will usually go home with your feeding tube still in, to make sure you get enough food and nutrients and do not lose weight. Before leaving hospital, your nurse or dietitian will show you how to use your feeding tube. If you have a carer, they can learn how to use it too. You will see the dietitian regularly as an outpatient to check how well you are eating. When you are eating and drinking enough, the tube can be removed.

We have more information about feeding tubes and nutritional support.

Recovering after your operation

You will still be recovering for some time after you go home. Try building up the amount you do slowly. Gentle exercise, such as regular walks, builds up your energy levels. You can increase the amount you do as you feel better. Everyone is different, and some people take longer than others to recover.

Avoid lifting heavy things like shopping, or doing vacuuming or gardening, for at least 8 weeks. This gives your wound time to heal.

Some insurance policies give specific time limits for not driving after surgery. Contact your insurance company to tell them you have had an operation. Most people are ready to drive about 4 to 6 weeks after their operation. Do not drive unless you feel in full control of the car.

We have more information about going home from hospital, which explains how to get support after you get home.

Outpatient appointment

Before you leave hospital, you will be given an appointment for your check-up at an outpatient clinic. The appointment is a good time to talk about any problems you have after your operation. If you have any problems before this appointment, you can contact your cancer doctor, specialist nurse or ward nurse for advice.

Eating

You probably will not feel like eating very much for a while, and it is common to lose some weight. You may feel full after eating small amounts. Some foods might make you feel sick, or give you indigestion or diarrhoea. It is important to try to eat, even if you do not feel like it. Over time, you will start to manage bigger portion sizes and different foods. If you continue to have problems, it can help to write down what is happening so you can limit or avoid certain foods. Talk to your cancer doctor or dietitian if you continue to have problems with food.

We have more information about eating after treatment for oesophageal cancer.

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Indigestion

Indigestion or reflux (a backward flow of digestive juices into the oesophagus) can happen after stomach surgery. This can cause pain and inflammation of the lining of the oesophagus. Your GP or cancer doctor can prescribe antacid medicines to help with this.

Avoid fizzy drinks, alcohol and spicy foods, as these may make your symptoms worse. Lying down may also make symptoms worse. After eating and drinking, try to stay sitting up for at least an hour. When you lie down to sleep, try using pillows to raise your head slightly.

Indigestion can also be caused by wind trapped in the digestive system. You can reduce wind by drinking peppermint water or taking charcoal tablets. You can buy these from a pharmacy.

Preventing weight loss

To start with, you may find it hard to not to lose weight. Your body will use lots of calories to help it recover from surgery, but you may not be eating as much as you normally would. But in time, most people find they stop losing weight.

You will usually see a dietitian, who will talk with you about the effects of surgery on your diet. They will give you advice about eating a balanced diet and building up your weight. To gain weight, you need to add more energy (calories) and protein to your diet. You can do this by:

  • eating high-calorie foods, such as crisps, cakes, biscuits and pastries
  • adding more calories to your food by using things like cream, butter or cheese
  • having nutritious, high-calorie and protein food supplements – these are available on prescription as liquids or powders.

Dumping syndrome

The stomach normally stores food and releases it into the bowel in a controlled way. After an operation to remove part of the oesophagus, food can travel more quickly through the digestive system. This can cause symptoms called dumping syndrome.

We have more information about nutritional support and diet problems after surgery.