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surgery for oesophageal cancer

If it is possible to try to cure your oesophageal cancer, your surgeon will remove part of your oesophagus.  How much the surgeon takes away depends on where in the oesophagus the cancer is.  There are 3 possible operations used to try to remove oesophageal cancer completely.  These operations are major surgery.  They are all done under general anaesthetic.  So you will be asleep for the entire operation.

You may have the part of your oesophagus that is cancerous removed and the healthy part reattached to your stomach, which the sugeon pulls up into the chest.  This is called partial oesophagectomy.  Sometimes, the surgeon may prefer to use a bit of bowel to replace the part of the oesophagus that has been taken out instead of joining the oesophagus directly to the stomach. 

You may need to have the whole of your oesophagus taken out.  If it is completely removed, the surgeon will take a piece of the large bowel (colon) and use it to replace the oesophagus.  So you will have an abdominal scar where the piece of bowel was removed.  This operation is called total oesophagectomy.  It is rare to remove the whole of the oesophagus.

If the cancer has spread to your stomach, you will need to have the upper part of your stomach removed, as well as the affected part of the gullet.  This is called an oesophagogastrectomy. 

How does the surgeon get to the oesophagus?

There are different ways of doing these operations on the gullet.  Your surgeon can approach the cancer via your neck, chest or abdomen.  Which is suitable depends mainly on where your cancer is in your oesophagus.  It may also depend, to some extent, on whether your surgeon prefers one type of operation or another.  You may hear the terms 'trans hiatal oesophagectomy' or 'trans thoracic oesophagectomy'.  This just describes the surgeon's approach.  The operations are also sometimes named after the surgeon that developed them.  Trans thoracic oesophagectomy is sometimes called an Ivor Lewis operation, for example.

Depending on which operation you have, you may have

  • A scar on your abdomen
  • A chest scar, on the right or left
  • A neck scar

Or you could have a combination of these.

Removing lymph nodes

During your operation the surgeon will examine the oesophagus and surrounding area.  He or she will take out some of the lymph nodes from around your oesophagus.  This is called lymphadenectomy.  The surgeon takes out lymph nodes because they may contain cancer cells that have broken away from the main cancer.  Taking them out reduces the risk of your cancer coming back in the future.  The lymph nodes will be sent to the laboratory and checked.  This will help your doctor work out the stage of your cancer.  And the stage helps to decide which treatment is best for you.

the operation

Surgical resection (removal) of the esophagus is indicated in several types of esophageal abnormalities, as well as for esophageal cancer. Your surgeon will choose one of several approaches for the removal of your esophagus and will describe the specific approach to be used for you.

Surgical Approach

After you have received your epidural for pain control and are asleep, the surgeon will remove the mass and form a replacement esophagus out of your stomach. The surgery will take approximately 6 hours. Additional time may be needed before surgery to insert intravenous lines and put you to sleep. The esophagus and associated lymph nodes will be sent to pathology for analysis. The final pathology report usually takes 10 to 14 days. The surgeon will notify you of your diagnosis as soon as he has the final report. If you have not heard from him within two weeks, please contact the office.

Left Transthoracic (Chest) Approach
Ivor-Lewis (Belly and Right Chest)
Three Hole Esophagectomy
(Right Chest/Belly/Left Neck)
Transhiatal (No Chest Incision)

Surgical Approaches

There are four currently used surgical approaches for an esophagectomy--Transthoracic, Ivor-Lewis, 3-Hole Esophagectomy and Transhiatal. Approaches are chosen by the surgeon in order for the esophagus, tumor or obstruction, and lymph nodes to be adequately removed. Sometimes a neck incision will need to be made instead of an abdomen incision due to the location of the tumor.

Feeding Tube

If you have not previously had a feeding tube placed, you will have one inserted into your small intestine during the operation. This will be used to feed you during the time you are not able to eat by mouth. It will help keep your body in optimal condition during the postoperative period and will be removed approximately 1 month after surgery.

Chest Tubes

During surgery, one or more chest tubes will be placed into your side. These chest tubes are used for drainage and to monitor air leakage. The tube is hooked up to an empty container, which will collect any fluid that drains out from your chest. The chest tube will remain in until the drainage stops and there is no air leakage.

Pain Control

Operations create pain. We make every effort to minimize your discomfort through oral medications, IV medications and epidural catheters. You will be asked frequently about your pain. Please be honest. It is very important for the pain to be under control because taking deep breaths and moving are essential for quick recovery.

  • PCA (Patient Controlled Analgesia): This is pain medicine that is given through your IV. You will be able to press a button connected to the pain medicine and dose yourself as needed. You do not need to worry about overdosing or becoming addicted. Limits will be programmed into the pump and you will not become dependent while you are having real pain.
  • Epidural Catheter: This is a very small tube placed in your back at the time of surgery. Pain medication is infused through the catheter, which will bathe the spinal cord and prevent pain. You may have a PCA button for your epidural pain medicine (see above).
  • Oral medications are most often given on an "as needed" schedule. This means that you must ask the nurse to give you the medicine. Usually, there is a 4 hour interval between doses. Please let your nurse know if you need your medicine more frequently or if it makes you too sleepy.

Deep Breathing, Coughing & Incentive Spirometry

It is very important to cough and deep breath after surgery. Your lungs need to be fully expanded to prevent infection and collapse. Please practice coughing and deep breathing before you come in for surgery.

  • Deep breathing: fill your lungs up slowly over a count of 5, hold for a count of 5, exhale slowly over a count of 5. REPEAT 10 TIMES per hour while you are awake.
  • Coughing: take two slow breaths filling your lungs up as much as possible. Begin your cough as you exhale the second time. Make sure you hold a pillow or towel over your incision (also called "splinting" your incision) during your cough. This will decrease the pain. REPEAT 10 TIMES per hour while you are awake.
  • Incentive Spirometry: Hold the spirometer securely in two hands and place your mouth on the mouth piece. Exhale around the mouth piece and make a tight seal on the mouthpiece. Inhale slowly to the count of 5 while you watch the disc move upward. Hold for a count of 5, loosen the seal around the mouthpiece & exhale. REPEAT 10 TIMES per hour while you are awake.


Walking and moving frequently are very important components of your recovery. The more you push yourself to exercise and move, the quicker and less painful your recovery will be. You may not feel up to moving, BUT YOU MUST. You will be up in the chair the night of surgery and walking in your room the next morning.


You will not be allowed to eat or drink ANYTHING for the first week after surgery. You will have a nasogastric tube (NG tube) inserted into your nose through your new "esophagus", past the internal incisions while you are in surgery. NO ONE except your attending surgeon should remove or reposition this tube. This tube will be attached to suction & will drain the fluid secreted by your stomach. Your nurse will flush this tube several times each day to keep it clear. As long as it is working properly, you should not feel nauseous or vomit. Tell your nurse if you do feel nauseous.

  • You will receive IV fluids for the first week. Any extra medicines you need will also be given through your IV.
  • You will begin feedings through the feeding tube in your abdomen on the first or second day after surgery. The amount of these feedings will be increased slowly over the next several days.
  • You will have a swallowing test within 7-14 days of your surgery. You will be given a special liquid to drink while x-rays are taken. If there are no areas of leaking fluid on the xrays , your doctor will remove your NG tube and you will be allowed to take sips of clear liquids. Your diet will be increased gradually to 6 small SOFT meals each day.


Risks & Potential Complications

Your surgeon will explain the risks and alternatives to surgery in detail with you. It is an extensive procedure, requiring a significant about of time under general anesthesia. Every possible precaution will be taken. The major risks of an esophagectomy are leaks from the internal suture line, pneumonia or infection, bleeding, abnormal heart rhythms, and rarely heart attack and death.

Specific major complications in patients undergoing oesophagectomy include respiratory failure, anastomotic leakage and delayed gastric emptying.

Atelectasis and respiratory insufficiency

These are common after transthoracic oesophagectomy. Good analgesia, physiotherapy, appropriate hydration and early mobilisation are all essential to minimise respiratory complications.

Anastomotic leakage

This may occur in the early post-operative period (2-3 days) when it is deemed due to technical failure or later (3-7 days) when it is thought more likely to be due to ischaemic changes in the stomach, usually close to the suture line. This is associated with significant mortality and morbidity. Occasionally, small radiologically demonstrated leaks are seen at 7-10 days but these can be clinically insignificant or associated with little disturbance. These may be treated conservatively with confidence. Early leaks or gastric ischaemia may be associated with profound acidosis and respiratory distress. Such signs should alert the team to the possibilities of a leak or ischaemia and prompt early investigation, preferably by endoscopy, but contrast swallow may also be of help. Early leaks and ischaemia should be treated aggressively by re-exploration and appropriate resection, defunctioning or re-anastomosis where appropriate.

Delayed gastric emptying

This may occur if the stomach lies redundantly in the thorax. Occasionally, it is a consequence of an intact pylorus in a transposed stomach. This complication is best avoided by accurate positioning of the stomach within the chest and ensuring a widely patent pylorus at the time of surgery. Any doubts about patency should lead to the formation of a pyloroplasty. Treatment of delayed gastric emptying is directed at enhancing gastric emptying with Metoclopramide and/or pyloric balloon dilatation