Surgery for oesophageal cancer

Oesophageal cancer that has not spread outside the oesophageal wall can generally be treated with surgery. Surgery aims to remove all of the cancer while keeping as much normal tissue as possible. The surgeon will remove some healthy tissue around the cancer to reduce the risk of the cancer coming back. You may have an endoscopic resection or an oesophagectomy depending on where the tumour is growing and how advanced the cancer is.

Learn more about:

• Endoscopic resection (ER)
• Oesophagectomy (surgical resection)
• How the surgery is done
• Risks of oesophageal surgery
• What to expect after oesophageal surgery
• Feeding tubes
• Common questions about surgery
• Video: What is surgery?

Endoscopic resection (ER)

Very early-stage tumours that have not spread from the oesophageal wall may be removed with an endoscope. For some people, an endoscopic resection may be the only treatment needed. This is usually a day or overnight-stay procedure. Preparation and recovery are similar to endoscopy.

Oesophagectomy (surgical resection)

This procedure removes the cancerous tissue and part or all of the oesophagus, leaving as much healthy tissue as possible. The goal is to completely remove the cancer, including nearby affected lymph nodes. It is common to have chemotherapy and/or radiation therapy before an oesophagectomy, as this has been shown to lead to better outcomes.

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

Once the cancerous sections have been removed, the stomach is pulled up and reconnected to the healthy part of the oesophagus. This will allow you to swallow and, in time, eat relatively normally. Occasionally, if the oesophagus cannot be reconnected to the stomach, the oesophagus will be connected to the small bowel or a piece of large bowel will be used to help you swallow.

How the surgery is done

To remove the cancerous tissue, the surgeon will need to access the upper abdomen and chest. This may be done in two ways:

• in an open oesophagectomy, the surgeon will open the chest and the abdomen with large surgical cuts
• in a minimally invasive oesophagectomy (keyhole or laparoscopic surgery), the surgeon will make some small cuts in the abdomen and/ or between the ribs, then insert tools into the cuts. One of the tools will have a light and camera so the surgeon can see inside the body.

The hospital stay and recovery time are fairly similar for both types of surgery. Although laparoscopic surgery usually means a smaller scar, open surgery may be considered a better option in many situations.

Risks of oesophageal surgery

As with any major surgery, oesophageal surgery has risks. These may include infection, bleeding, blood clots, damage to nearby organs, leaking from the connections between the oesophagus and stomach or small bowel, pneumonia and paralysis of the vocal cords. Some people may experience an irregular heartbeat, but this usually settles within a few days. Narrowing of the oesophagus from surgical scars (known as oesophageal stricture) can make it difficult to swallow. Your doctor may perform a procedure to stretch the walls of the oesophagus (dilatation). Some people need to have only one dilatation, others need many. Your surgeon will discuss these risks with you before surgery, and you will be carefully monitored for any side effects.

After surgery my oesophagus would not stay open due to scar tissue pulling tight … Nearly two years after surgery I still have to have my oesophagus dilated monthly.   — Grant