Surgery for esophageal cancer

Surgery for esophageal cancer aims to cure your cancer. Surgery is an option for people whose tumors have not spread to other organs and whose tumors can be removed in their entirety. You need to be healthy enough to be able to handle the surgery. You may benefit from a combination of chemotherapy and radiation therapy in order to shrink the tumor in preparation for surgery.

The surgery will remove most of your esophagus, from your neck until the part where the esophagus meets the stomach, as well as all corresponding lymph nodes. Your surgeon will then proceed to repair the connection between mouth and stomach by crafting a gastric tube from the greater curvature of the stomach.

Surgery for esophageal cancer - what to expect

You will be under general anesthesia during this procedure. Your anesthesiologist will place an epidural catheter to administer painkillers during and after your surgery.

Inspection

Most esophageal surgeries are abdominal surgery. Your surgeon will determine whether the tumor has spread through the abdomen and whether the tumor is attached to your vital organs. If necessary, your surgeon will take biopsies for rapid diagnostics. Your esophagus (and lymph nodes) may need to be removed through a chest procedure during the same operation. When possible, the abdominal and chest surgeries will be laparoscopic (keyhole surgery).

Gastric tube

Your surgeon will craft a gastric tube from the greater curvature of the stomach. Afterwards, the operation will continue in the neck, usually on the left. After the removal of the esophagus, the gastric tube will be pulled up towards the neck where the connection (anastomosis) is formed between the remaining parts of the esophagus and the gastric tube.

Drains

The final step is the placement of surgical drains (in the neck and, if required, in the chest and abdomen) in order to remove fluids and blood from the wound, and a feeding tube in the small intestine (jejunostomy tube).

Effectiveness

The surgery aims to cure you by removal of the tumor and all lymph nodes in the area. Sometimes we detect metastases during surgery. This will end the procedure.

Preoperative screening

For a full recovery, it is essential that you are in good shape before the surgery. If you struggle to eat enough food, you will receive liquid meals or tube feedings (through a flexible tube that is placed into the stomach or small intestine). If necessary, a physical therapist will help you improve your overall health.

Side-effects and complications

All surgical procedures carry risks. Through several preventative measures, we try to minimize these risks.

Potential complications

You may be at risk of developing pneumonia, cardiovascular problems, infection, or an anastomotic leak at the surgical join.

Food and drink

The surgery may affect your appetite and sense of taste. It will also affect the portion sizes you can eat. Some patients experience reflux – the flow of food, drink, or bile in the wrong direction. Consuming smaller portions will alleviate the symptoms. Try not to bend over directly after eating. If needed, there are several prescription drugs that can help. You will receive tube feeding directly after surgery. Your dietician will help you make adjustments to your diet when transferring to a solid diet.

Passage

If the new gastric tube is narrower than before due to scarring, your gastroenterologist can enlarge (dilate) the passage through endoscopic stenting. This will involve various steps. The first dilation will be performed approximately 6 weeks after your surgery.

Problems swallowing or hoarseness

You may experience problems swallowing, or hoarseness after surgery in the neck. These problems tend to be temporary. If needed, you can consult a logopedist.

Surgery for esophageal cancer

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