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Having your oesophageal cancer operation

Men and women discussing non oesophageal cancer

This page is about what happens when you have major surgery for cancer of the food pipe (oesophagus). You can find the following information

 

A quick guide to what's on this page

Before your operation for oesophageal cancer

Before your surgery, you will need further tests to make sure you are fit enough for your anaesthetic and to make a good recovery. These may include blood tests, a chest X-ray, tests to check how well your lungs are working and a heart trace (ECG) while you are exercising. You will also need to learn breathing and leg exercises.

About 1 to 2 weeks before surgery you have an appointment at the hospital pre assessment clinic. This prepares you for your operation and makes sure you are in the best possible health before surgery. You may meet several members of your multi disciplinary team, including a surgeon, nurse, dietician and physiotherapist. It is a good idea to take a list of questions you may have to this appointment.

You will go into hospital the day before or morning of your surgery.

After the operation

When you wake up, you are likely to have several tubes in place. Some give you fluids, painkillers and blood transfusions. Others drain the wound, drain your urine, and drain fluid from your stomach to stop you feeling sick. Tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you.

You will not be able to eat or drink straight away and so you have fluids through your drip. You may be allowed to moisten your mouth with small sips of water. You will gradually start eating and drinking. The hospital dietician will give you help and advice with managing your diet during your stay and afterwards.
 

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Before your operation

This section is about what to expect before you have your operation. You can find information on

Tests to find out how fit you are for surgery

You may have had some of these tests while your cancer was being diagnosed. If so, you may not need to have them again. You may have

  • Blood tests to check your general health and how well your kidneys are working
  • A chest X-ray to check your lungs are healthy
  • An ECG to check your heart is healthy
  • Breathing tests (called lung function tests)
  • An ECG while you are exercising (cardiopulmonary exercise test)
  • An echocardiogram (a painless test of your heart using sound waves)

These tests are to make sure you are fit enough for your general anaesthetic and to make a good recovery from your surgery.

Pre assessment clinic

About 1 to 2 weeks before your surgery you have an appointment at the hospital pre assessment clinic. This prepares you for your operation and makes sure you are in the best possible health before surgery. You are likely to meet several members of your multi disciplinary team, including a surgeon, nurse, dietician and physiotherapist.

A member of the surgical team will give you information about surgery, the benefits and possible risks, and what to expect afterwards. You may also meet the anaesthetist who will make sure you are fit enough for the surgery. You may sign the consent form to agree to the operation during this appointment.

The nurse will check your general health, weigh you, and take your blood pressure, pulse and temperature. They may take blood tests and arrange any other tests if needed. They will assess what help you may need after surgery once you are well enough to go home. They can also help answer any questions you may have.

The physiotherapist will assess how well you can move around and let the doctors know if there are any issues that may affect your recovery after surgery. They will also teach you leg and breathing exercises to do after your operation to help with recovery.

The dietician will give you help and advice about managing your diet before and after your surgery. They can give useful tips on how to increase the nutrients and calories in snacks, meals and drinks. They may give you supplement nutritional drinks to have before surgery. You may need a feeding tube into your stomach or small bowel before or after surgery to make sure you get the nutrition you need. The dietician will give information and support with this.

Do ask as many questions as you need during this appointment. It may be a good idea to write down all your questions to take with you. There are some suggestions for questions at the end of this section. The more you know about what is going to happen, the less frightening it may seem. Don't worry if you think of more questions later. Just speak to your clinical nurse specialist or the nurses on the ward. They can answer your questions or ask the doctor to talk to you again.

Learning breathing and leg exercises

Your physiotherapist or nurse will teach you breathing and leg exercises. You can help yourself to get better by doing these exercises after your operation. You should do them as often as you are told you need to. 

Breathing exercises will help to stop you getting a chest infection. If you smoke, it really will help if you can stop at least a few weeks before your operation. You will be less likely to get a chest infection afterwards if you do stop.

Leg exercises help to stop clots forming in your legs. You may also have drugs to stop the blood from clotting so easily. You usually have them as small injections of heparin, tinzaparin or daltarparin just under the skin. These usually start just before the surgery and continue for about 4 weeks afterwards. Your nurse may also give you compression stockings to wear.

Both chest infections and blood clots can happen if you are not moving around as much as you would normally. Your nurses will encourage you to get up and about as soon as possible after your operation.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.
 


View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

At the hospital

You may go into hospital on the morning of your operation or the day before. If you have any further questions the nurses can arrange for a member of the surgical team to come and talk to you again. You will sign the consent form for the operation if you didn't do it at the pre assessment clinic.

If you have been finding eating and drinking difficult, your doctor may want you to have a drip (intravenous infusion) put into your arm before your surgery. You can have fluids through this so that you are not dehydrated before your operation.

Lastly, if you have body hair on your chest or abdomen, you may need a shave before your operation. Shaving may lower the risk of an infection getting into your wound. You may have your shave on the ward, or in the operating theatre while you are under anaesthetic.

 

When you wake up after your operation

If you have had a big operation you may wake up in intensive care (ICU) or a high dependency recovery unit. This is routine after a big operation and as soon as your doctors are sure you are recovering well, you will be moved back to the ward. This is usually within a day or so. In ICU you have one to one nursing care, and are checked very regularly. Again this is normal and doesn't mean there is anything wrong. Your surgeon and anaesthetist will keep a close eye on your progress. ICUs are very busy places and can be noisy. You'll be feeling drowsy because of the anaesthetic and painkillers. Some people find the experience of being in ICU a bit strange and disorientating.

When you wake up, you will have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You will have

  • Drips (intravenous infusions) to give you blood transfusions, and fluids until you are eating and drinking again
  • One or more drains coming out of your chest or abdomen near your wound
  • A tube into your bladder (catheter) so that your urine output can be measured

You will always have a chest drain after any surgery to the chest. This is because any operation on the chest causes the lung on that side to collapse. The chest drain may be connected to gentle suction. This helps your lung to inflate properly again over the next few days. When your doctor thinks your lung is fully inflated, you will have a chest X-ray. If that looks ok, your nurse will take the chest drain out by pulling on it gently. Another nurse will be standing by ready to tighten up the stitch around the drain site as soon as the tube comes out.

The tube coming out of your abdomen is to drain blood and fluid away from the operation site. This helps it to heal. Sometimes wound drains are connected to collecting bottles or bags. Your nurse will empty these daily and record how much is in them. Your nurse will take the tubes out once they have stopped draining. This is generally 3 to 7 days after surgery. Again, they are just gently pulled out.

When you first wake up, you will have a small tube (cannula) in an artery in your arm which is connected to a monitor to measure your blood pressure. Once you are well enough this will change to a blood pressure cuff on your arm. You will have a little clip on your finger to measure your pulse and blood oxygen levels. This is called a pulse oximeter. 

You may also have an oxygen mask on for a while. Your nurse will keep a close eye on your blood pressure for the first few hours after you come round from the anaesthetic. Your nurse will also measure and record how much urine you pass because it can help show whether you have too much fluid or are becoming dehydrated.

You may have a couple of electronic pumps attached to your drips. These are for controlling any medication you might be given through your drip.

 

Painkillers

You will almost certainly have pain for the first week or so. But there are many different pain killing drugs you can have. It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

You may have an electronic pump attached to your drip for your painkillers just after surgery. These usually have a hand control, with a button to press to give yourself extra painkillers as you need them. This is called PCA or patient controlled analgesia. Do use it whenever you need to. You can’t overdose because the machine is set to prevent that. Do tell your nurse if you need to press the button very often. You may need a higher dose in the pump.

Some surgeons and anaesthetists prefer to give painkillers into the spine (an epidural) for the first day or so after surgery. This usually works really well. You have a very thin tube put into your back, into the space that surrounds your spinal cord. This is all done while you are under anaesthetic. When you wake up, you will find the tube is taped to your back. It connects to a pump, which gives you a continuous dose of painkiller. Tell your nurse if you are still in pain and they can increase the dose.

 

Eating and drinking

After surgery to any part of the digestive system, the bowel often stops working for a while. You will not be able to eat or drink straight away and so you have fluids through a drip. You may be allowed to moisten your mouth with small sips of water.

During your surgery, the surgeon may have put a feeding tube (jejunostomy) into part of your small bowel called the jejunum. If so, you may be fed through this tube from about 24 hours after your operation. In some cases, it might be necessary to give you nutrition directly into a vein. This is called parenteral nutrition.

You may be able to start drinking small amounts of water about 48 hours or so after surgery. Because you have had surgery to your food pipe, you will need to start very gradually at first. You usually start off with sips of clear fluid. If you manage those, the amount you can have will slowly increase. Then you move on to other drinks such as milk, tea and soup. Once you are able to drink without feeling or being sick, your drip can come out.

Some surgeons like to do a test before allowing you to start eating. This is an X-ray, similar to a barium swallow. It just makes sure there are no leaks where the oesophagus has been stitched to either the stomach, another part of the oesophagus or to a section of bowel. You have to swallow a type of dye called Gastrograffin. The dye shows up any leaks clearly on the X-ray. Some surgeons prefer to do this test just before you go home. Others don't use it at all, unless they are concerned that there may be a leak.

If you have had the lower third of your oesophagus removed, your surgeon will also have taken out the valve at the top of your stomach, (the lower oesophageal sphincter). This valve is there to keep the contents in the stomach away from your oesophagus. After your operation, you may find that you have some acid reflux. Your doctors can give you antacids to relieve this. It will also help to make sure you stay sitting upright for a couple of hours after eating. Your surgeon may advise you not to lie flat in bed, but to sleep propped up on a couple of pillows. And not to bend down with your legs straight. You should lift by squatting down, with your knees bent.

There is a lot of information about managing diet problems in cancer in our cancer section on coping physically with cancer.

 

Your wound

Your wound will be covered up with a dressing when you come round from the operation. Usually, wounds like this are left covered for a couple of days. Then your nurse will change the dressings and clean the wound. Your stitches or clips will be left in for at least 10 days. Usually these are taken out before you go home. But sometimes, if the wound is not quite healed but you are otherwise well, you can go home with them in. You can either come back to the hospital to have them taken out or go to your GP's surgery for the practice nurse to do it. Or a district nurse will visit you at home and remove the stitches there.

 

Getting up

Your nurses and physiotherapist will encourage you to get up and about as soon as possible as it helps you to recover more quickly. They will help you to sit out in a chair at least 6 to 12 hours after your operation. The next day they will help you to walk around your bed. Within a few days you hopefully will be able to walk along the hospital corridor with help. Your physiotherapist will visit you everyday to help you with your breathing and leg exercises.

Gradually your drips and drains will come out so it will be easier to get around. Then it will really feel that you are making progress. You will probably be able to go home about 10 days after your operation.

 

Making progress

After a few days you will be up and about more. Gradually you will start to feel better. Soon you will be able to eat more. At first you will find it easier to have lots of very small meals rather than 3 large meals a day. You will see the dietician throughout your hospital stay and before you go home. They will give you help and advice with managing your diet.

There is information about diet after oesophageal surgery in the living with oesophageal cancer section.

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Updated: 14 April 2014