Oesophagectomy

Depending on where the cancer is in the oesophagus, there are different types of surgery. The 2 main ways a surgeon can do your operation are a trans-thoracic or a trans-hiatal oesophagectomy. But some people may have keyhole surgery.

After surgery to the oesophagus, 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 how much you can eat and drink.

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.

The surgeon does this operation through a few small cuts in the tummy (abdomen), rather than 1 large opening. It is sometimes called laparoscopic 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. Depending on the part of the oesophagus they need to reach, they might work in different areas of the body. A thoracoscopy looks inside the chest, and a laparoscopy looks inside the tummy.

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.

Surgeons sometimes use robotic surgery to treat oesophageal cancer. The surgeon uses controls to move robotic arms that hold the surgical instruments. Having robotic surgery can reduce side effects for some people and may mean they spend less time in hospital.

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-operative 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 meet the doctor who gives you the anaesthetic (anaesthetist) when you are at a clinic. Or you may meet 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 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 you may want to ask questions. Talk to your surgeon or specialist nurse if there is anything you do not understand.

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 will get information about exercises you can do to help you get fitter before surgery. You will also get information about 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.

You will still be recovering for some time after you go home. Try slowly building up the amount of physical activity you do. 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.

Before you leave hospital, you will be given an appointment for your check-up at an outpatient clinic. You may also be given contact details for your specialist nurse. 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.

You probably will not feel like eating very much for a while, and you may 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. If you continue to have problems with food, talk to your cancer doctor or dietitian.

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

Indigestion or reflux is a backward flow of digestive juices into the oesophagus. You may have it after oesophagus 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. You can buy this from a pharmacy.

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

You will usually meet 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 high-protein food supplements – these are available on prescription as liquids or powders.

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.