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 – The surgeon removes the part of the oesophagus containing the cancer.
  • 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, together with the affected part of the oesophagus.
  • Total oesophagectomy – Rarely, the whole oesophagus needs to be removed.

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 a single, larger cut. The surgeon will use special instruments to see and work inside the chest and tummy.

Very early-stage oesophageal cancers can sometimes be treated using endoscopic mucosal resection (EMR). This may be followed by further treatment, to destroy any cancer cells that might be left.

Surgery overview

If the cancer is at an early stage, you may have surgery 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 with you about the best type of surgery for your situation. It is important to discuss the operation 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 2 main types of operation used to treat oesophageal cancer

Oesophagectomy

The part of the oesophagus containing the cancer is removed. This operation is used when the cancer is only in the oesophagus. The stomach is then pulled up and joined to the bottom of the oesophagus.

An oesophagectomy
An oesophagectomy

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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. You will need to have the top of your stomach removed, together 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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Total oesophagectomy

Rarely, the whole oesophagus needs to be removed. This is called a total oesophagectomy. Your stomach will be pulled up into your neck to replace the removed oesophagus.

Total oesophagectomy
Total oesophagectomy

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Surgery to the lymph nodes

During your operation, the surgeon will remove a small area of healthy tissue around the oesophagus. They will also remove some of the nearby lymph nodes. This is called a lymphadenectomy. A pathologist will look at the lymph nodes under a microscope to see if they contain cancer cells. Removing the lymph nodes 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 2 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. This is also called a two-stage oesophagectomy. Sometimes a third cut is made in the neck, which is called a three-stage oesophagectomy.
  • Trans-hiatal oesophagectomy – Cuts are made in the tummy and neck to remove the part of the oesophagus containing the cancer.

After these operations, your stomach will be higher than it was before. It will be above, instead of below, the sheet of muscle (diaphragm) that divides the chest from the tummy. Your stomach will also be smaller. This is because it has been shaped into a tube to replace the oesophagus, which has been removed. This will change your eating and drinking habits.

Sometimes, it is 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 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.

Possible risks of surgery

Your surgeon will explain the possible risks with this type of surgery before you have your operation. You will have tests to check your heart and lungs, to make sure you are fit enough to have it.

Some of the possible complications of this type of operation may be life-threatening. You may need to stay in the intensive care unit for a period of time after surgery. Other risks include getting a chest infection or pneumonia, bleeding, or problems with the wound healing properly. It can take a while to recover from the operation. It is important to discuss these risks with your surgeon before agreeing to have the surgery.

Keyhole surgery

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

During the operation, the surgeon may decide that 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.

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, you have an endoscopy 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. The doctor either injects fluid into the layer of cells below the cancer or uses gentle suction to do this. 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. They may use a treatment called radiofrequency ablation (RFA) in this situation.

Back to Surgery

Who might I meet?

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