Surgery for oesophageal cancer

Doctors and nurses in surgery

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Surgery is the most common treatment for cancer that hasn’t spread outside the oesophagus. You’ll have tests before surgery to make sure you are well enough. Read more about getting ready for surgery.

Types of surgery

Your surgeon may remove the whole oesophagus or just the part that has cancer. It depends where the cancer is.

Because the oesophagus is a long tube your surgeon may need to make a cut (incision) or cuts in your chest, tummy (abdomen) or neck to remove the tumour, depending on where it is.

Oesophagectomy

The part of your oesophagus with cancer is removed, along with lymph nodes and nearby soft tissues. The surgeon pulls up your stomach and joins it to the remaining part of your oesophagus. Rarely it’s not possible to join your stomach to the remaining part of the oesophagus. In this case, a section of your bowel (colon) will be used to replace part of the oesophagus. 

Oesophagectomy (Image courtesy of Cancer Research UK / Wikimedia Commons)

Oesophago-gastrectomy

If the cancer has spread to your stomach, the upper part of your stomach can be removed, as well as the affected part of your oesophagus. This is called an oesophago-gastrectomy. A piece of bowel may be used to join the remaining part of your oesophagus to your small bowel. 

Total oesophagectomy

You may need to have your entire oesophagus removed. This is called a total oesophagectomy, but it is rarely done. 

Removal of lymph glands (lymphadenectomy)

During the surgery your surgeon will take out some of the lymph nodes from around your oesophagus. This is called lymphadenectomy. If the lymph nodes contain cancer, removing them can help to stop it spreading. The lymph nodes removed will be looked at under a microscope to give your doctor more information about the stage of your cancer.

After oesophageal surgery

  • You may spend a short time in an intensive care unit after your operation. 
  • You may have a nastogatric tube up your nose. It’s used to keep your stomach empty by removing any fluid from your stomach. This will stop you from feeling sick and let your wound heal. It is usually removed after 48 hours.
  • You may also have a small feeding tube placed directly into your small bowel. This is called a jejunostomy or a JEJ tube. The tube is put in through your tummy during surgery. It can be used to give you all the calories, protein and nutrients you need until you are ready to eat and drink again.
  • Most people are ready to go home 10–14 days after surgery

Read more about recovering after surgery.

Starting to eat and drink again

You will only be allowed sips of fluid after the surgery until your surgeon is happy that the join made in your oesophagus has healed. Then the amount of fluids you can take will be increased.

When you are managing fluids, you can start to eat small amounts of soft food. Eat slowly and chew your food well to help you to feel more confident with swallowing.  Your dietitian will be there to support you and advise you on what foods to eat to make sure you’re getting enough calories and nutrients.

Once you begin to eat and drink reasonable amounts, the tube feeding may be gradually reduced and then stopped altogether. If you cannot take enough food by mouth, the tube feeding can be continued for as long as needed

Weight loss

It’s normal to lose some weight after surgery. Once you’re eating and drinking again weight loss should improve. The dietitian will support you managing your weight and any eating problems.

Your diet after oesophageal surgery

It may take a while for your stomach to get back to normal. Food may stay in your stomach longer or be ‘dumped’ into the small bowel quickly. Depending on your surgery, you may be advised to eat small meals regularly.

Fatty diarrhoea, bloating, wind and failure to gain weight can be signs you’re not absorbing or digesting your food. 

With oesophageal cancer, you are likely to have some weight loss. You may need to eat a special high-calorie diet and take supplements. The dietitian at the hospital can advise you about this.

If you have any problems with eating or weight loss or if you have bowel problems after surgery, tell your doctor and ask to talk to the hospital dietitian. We have more information on eating problems, or you can read our booklet Diet and Cancer. 

 

Publications
Helpful reading for oesophageal cancer patients/carers
Diet and Cancer booklet
Diet and Cancer - A guide for patients and families booklet
This booklet has been written to help you learn more about diet and cancer. It is aimed at people with cancer at any stage. It would also be useful to people who are caring for someone with cancer.

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