Oesophageal Cancer

What is surgery for oesophageal cancer?

In early stage oesophageal cancer, surgery to remove cancer is usually used as the main mode of treatment. In later stages oesophageal cancer, surgery is usually used in combination with other treatments such as chemotherapy or radiotherapy. Depending on how advanced the cancer is, surgeries to treat oesophageal cancer include:

  • Surgical removal of tumours which are very small. If your tumours are very small and confined to the outer layers of your oesophagus, your surgeon may remove the cancer and margin of healthy tissue surrounding it. Surgery is performed by an endoscope passed down your throat and into your oesophagus.
  • Surgical removal of part of your oesophagus, which is known as esophagectomy. Your surgeon removes the part of your esophagus which contains the tumour, together with a portion of the upper part of your stomach, and nearby lymph nodes. The remaining oesophagus is reconnected to your stomach.
  • Surgical removal of part of your oesophagus and the upper portion of your stomach, which is known as oesophagogastrectomy. Your surgeon removes part of your oesophagus, nearby lymph nodes and a huge portion of your stomach. The remaining stomach is then reconnected to your esophagus. Part of your colon may be used to help join these organs.

What are the types of surgery for oesophageal cancer?

Open surgery and laparoscopic (keyhole) surgery can both be used, depending on the location of the cancer in your oesophagus. Open surgery is used in most cases.

In open surgery, your surgeon can make a cut into your neck, chest or stomach. Two cuts are made to reach your oesophagus. In trans hiatal oesophagectomy, which means operation is done through a cut in your neck and stomach. In trans thoracic oesophagectomy (known as Ivor Lewis operation) which is when the operation is done through cuts in your abdomen and chest.

In laparoscopic surgery, four to six small cuts are made in your stomach. A long tube called a laparoscope is used. It is connected to a camera which shows your internal organs through a video screen. This helps your surgeon put in instruments into your body through the other incisions. Using the laparoscope and the other instruments, your surgeon frees the stomach so that it can be moved into the chest. The tumour is removed and your stomach joined to the remaining oesophagus.

The cut with open surgery is usually in the chest (thoracotomy), on your side. Laparoscopic surgery takes around 6 to 8 hours and is longer than open surgery.

What to expect?

Before the surgery

  • Stop smoking one week before the procedure to decrease risk of breathing difficulty and infection after the surgery.
  • Stop taking certain medications a week before the procedure.
  • Do aerobics exercises for around an hour every day to build up your strength so that you will be able to recover more quickly after surgery.
  • Do breathing and coughing exercises every day to help expand your lungs.
  • Eat a healthy and balanced diet.
  • Drink only clear fluids two days prior to the procedure.
  • You may be administered fleet to help you clear your bowels.
  • Fast as instructed by your doctor.

During the surgery

  • You will be given anaesthesia through an IV line to help you fall asleep.
  • Once you are asleep, a breathing tube will be placed down your mouth into your windpipe. This helps you breathe.
  • You will also have a urinary catheter to collect urine from your bladder.
  • When the surgery is completed, your incisions will be closed with stitches and your breathing tube removed.

After the procedure

  • You may have several tubes attached to you when you wake up. These tubes help to drain fluids out of your body and deliver painkillers and required nutrients until you are able to eat again.
  • A feeding tube may be necessary if your oesophagus is completely removed or there is significant scarring and narrowing after surgery.
  • Otherwise, you may consume your regular diet after a month. Do note that you may have to eat smaller amounts due to the reduced size of your stomach.
  • You may be given nutritional supplements.
  • You may be discharged from the hospital one to two weeks after the surgery.
  • You will be able to return to normal activities within three weeks.
  • Fix a follow up appointment with your doctor one week post-surgery.