Surgery for oesophageal cancer

When oesophageal cancer is inside the oesophageal wall, surgery is often recommended as long as you are well enough.

Surgery aims to remove all of the cancer while keeping as much normal tissue as possible. The surgeon will also 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:

• How the surgery is done
• Oesophagectomy (surgical resection)
• Risks of oesophageal surgery
• What to expect after oesophageal surgery
• Feeding tubes

How the surgery is done

To remove the cancer, the surgery can be done in two ways:

• in open surgery – the surgeon will make a large cut in the chest and the abdomen
• in laparoscopic surgery (minimally invasive or keyhole surgery) – the surgeon will make some small cuts in the abdomen and/or between the ribs, then insert 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. This may be used to join the oesophagus and stomach back together.

Laparoscopic surgery usually means a smaller scar, which means the hospital stay is shorter and the recovery faster, but it’s not always possible to have this type of surgery. Open surgery may be considered a better option in many situations.

Oesophagectomy (surgical resection)

Surgery to remove part or all of the oesophagus is called oesophagectomy. Nearby affected lymph nodes are also removed. It is common to have chemotherapy and/or radiation therapy before surgery, as this approach has been shown to have better results.

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 will allow you to swallow and, in time, eat relatively normally. If the oesophagus cannot be rejoined to the stomach, the oesophagus will be connected to the small bowel, or a part of the bowel will be used to replace the part of the oesophagus that was removed. These procedures will help you swallow.

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 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.

Surgical scars can narrow the oesophagus (known as oesophageal stricture) and make it difficult to swallow. If the oesophagus becomes too narrow, your doctor may need to stretch the walls of the oesophagus (dilatation). For some people, this procedure may need to be repeated several times. Your surgeon will discuss these risks with you before surgery, and you will be carefully monitored for any side effects.

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