Surgery for oesophageal cancer

When is surgery recommended?

Surgery is often recommended if oesophageal cancer has not spread to other parts of the body. The aim is to remove all of the cancer while keeping as much healthy tissue as possible. The surgeon will also remove some healthy tissue around the cancer (a margin) to reduce the risk of the cancer coming back in the future.

Depending on where the tumour is growing and how advanced the cancer is, you may have an endoscopic resection or an oesophagectomy.

The surgery can be done in 3 ways:

• open surgery – the surgeon makes a large cut in the chest and the abdomen, and, sometimes, a small cut in the neck
• keyhole surgery – the surgeon makes some small cuts in the abdomen and/or between the ribs, then inserts a thin instrument with a light and camera (laparoscope) into one of the cuts to see inside the body. Sometimes, a small cut is made at the base of the neck on the left side
• robotic surgery – a type of keyhole surgery where the surgeon uses robotic tools to remove cancer from the oesophagus through small cuts in the abdomen and/or chest.

Your surgeon will talk to you about the best type of surgery for you. Learn more about cancer surgery.

Oesophagectomy (surgical resection)

Surgery to remove part or all of the oesophagus is called an oesophagectomy. Nearby affected lymph nodes are also removed. Many people have chemotherapy before and after surgery, as this approach has been shown to have better long-term results. Your treatment team will recommend the best option for you.

Depending on where in the oesophagus the cancer is, the surgeon may also remove part of the upper stomach. This is the preferred option for cancer that has spread deeper into the wall of the oesophagus or to nearby lymph nodes.

Once the parts with cancer have been removed, the stomach is pulled up and rejoined to the healthy part of the oesophagus. This could be in the upper chest area or in the neck. The surgery will allow you to swallow and, in time, eat relatively normally.

Risks and side effects

As with any major surgery, oesophageal surgery has risks and side effects. These may include infection, bleeding, blood clots, damage to nearby organs, leaking from the joins between the oesophagus and stomach or small bowel, pneumonia and voice changes. Some people may have an irregular heartbeat, but this usually settles within a few days.

Surgery can sometimes cause scars that narrow the oesophagus. This is called oesophageal stricture and may make it difficult to swallow. If the oesophagus becomes too narrow, your doctor may need to gently stretch it (called dilatation).

Endoscopic resection

Endoscopic resection is a way for doctors to remove tissue from the oesophagus without needing more major surgery. A thin tube is passed through the mouth and into the oesophagus. An endoscopic resection helps with diagnosis and staging. For some people with early-stage oesophageal cancer, it may also treat the cancer by removing the whole tumour.

An endoscopic resection is often done as a day procedure but in some cases, you may need to stay in hospital overnight for observation.

What to expect after oesophageal surgery

Recovery time

You will most likely be in hospital for 7–10 days, but you may stay longer if you have any complications. It is likely to take 6–12 months to feel completely recovered after an oesophagectomy.

Eating and drinking

You will not be able to eat or drink straight after surgery. A feeding tube is often inserted during surgery. Your first foods will usually be fluids such as soup. You will then move on to pureed foods, then soft foods, and eventually solid foods. It is best to eat 5–6 small meals throughout the day, as you may feel full quickly.

Drips and drains

You will have drains in the chest after surgery and maybe other drains in the abdomen or neck. These will be removed before you go home. You may also have a feeding tube to get the nutrition you need, and another tube (nasogastric or NG tube) to drain fluids from the stomach. The NG tube will be removed before you leave hospital, but a feeding tube may stay in place when you leave the hospital.

Breathing problems

Controlling pain will help avoid problems with breathing that can lead to pneumonia. A physiotherapist can teach you exercises to help keep your lungs clear. You may also be shown how to use an incentive spirometer, a device to help your lungs expand and prevent a chest infection.

Having a feed tube

Some people with oesophageal cancer may need a feeding tube before, during or after treatment. This helps keep your weight steady and gives your body strength. A feeding tube can go into your stomach or small bowel. It may be placed through your nose (nasogastric or nasojejunal tube) or through your belly with a small operation (gastrostomy or jejunostomy tube). You might need the tube after surgery until you can eat and drink normally again.

A special liquid food (called formula) goes through the tube to give you the nutrients you need. If you go home with the feeding tube, a dietitian will tell you how much formula to take and how often. Your health care team will show you how to keep the tube clean and working well. The doctor will remove the tube when you no longer need it.