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Surgery to remove oesophageal cancer

Men and women discussing non oesophageal cancer

This page is about the surgery used to try to cure cancer of the food pipe (oesophagus). You can find the following information

 

A quick guide to what's on this page

Surgery to remove oesophageal cancer

If it is possible to try to cure your oesophageal cancer, your surgeon will remove part or all of your food pipe (oesophagus). How much the surgeon takes away depends on where in the oesophagus the cancer is. There are various possible operations used to try to remove oesophageal cancer completely. These operations are major surgery. They are all done under general anaesthetic. You may need to travel to a specialist centre to have your surgery.

If the cancer has grown into your stomach, you will need to have the upper part of your stomach removed, as well as the affected part of the oesophagus. This is called an oesophago gastrectomy. You may need to have the whole of your oesophagus taken out. This operation is called a total oesophagectomy. 

Removing lymph nodes

During your operation the surgeon will take out some of the lymph nodes from around your oesophagus. This is because they may contain cancer cells that have broken away from the main cancer. Taking them out reduces the risk of your cancer coming back in the future. The lymph nodes are sent to the laboratory to be checked. This will help your doctor work out the stage of your cancer. The stage helps doctors to decide which treatment is best for you.
 

CR PDF Icon View a summary of treating oesophageal cancer.

 

 

Which operations are done

If it is possible to try to cure your oesophageal cancer, your surgeon will remove part or all of your oesophagus. There are various possible operations surgeons can use to try to remove oesophageal cancer completely. The type of operation you have depends on

If you have high grade Barrett's oesophagus or a very early oesophageal cancer, you may have an endoscopic mucosal resection (EMR) instead of surgery. You may need to have radiofrequency ablation (RFA) or photodynamic therapy (PDT) afterwards to destroy any abnormal cells or cancer cells that may be left.

The operations to remove oesophageal cancer are major surgery. They are all done under general anaesthetic. So you will be asleep for the entire operation. You may need to travel to a specialist centre to have your surgery.

If the cancer has grown into your stomach, you will need to have the upper part of your stomach removed, as well as the affected part of the food pipe. This is called an oesophago gastrectomy.

Diagram showing before and after an oesophago-gastrectomy

You may have the affected part of your oesophagus removed and the healthy part reattached to your stomach, which the surgeon pulls up into the chest.

Diagram showing before and after a partial oesophagectomy

Sometimes, the surgeon may prefer to use a bit of bowel to replace the part of the oesophagus that has been taken out instead of joining the oesophagus directly to the stomach.

You may need to have the whole of your oesophagus taken out. This operation is called a total oesophagectomy. The surgeon will pull the stomach up into the chest and use it to replace the oesophagus.

Diagram showing before and after a total oesophagectomy

Sometimes, the surgeon may have to take a piece of the large bowel (colon) and use that to replace the oesophagus. You will have an abdominal scar after a total oesophagectomy.

Diagram showing a total oesophagectomy using bowel to replace the oesophagus

 

How the surgeon reaches the oesophagus

There are different ways of doing these operations on the food pipe. Your surgeon can approach the cancer via your neck, chest or tummy (abdomen). Which is suitable depends mainly on where the cancer is in your oesophagus. It may also depend, to some extent, on whether your surgeon prefers one type of operation or another. You may hear the terms trans hiatal oesophagectomy or trans thoracic oesophagectomy. This just describes the surgeon's approach. The operations are also sometimes named after the surgeon that developed them. Trans thoracic oesophagectomy is sometimes called an Ivor Lewis operation, for example.

Depending on which operation you have, you may have

  • A scar on your abdomen
  • A chest scar, on the right or left
  • A neck scar

Diagram showing the possible scar lines after surgery for oesophageal cancer

Or you could have a combination of these.

 

Keyhole surgery

Keyhole surgery to remove the oesophagus is still quite new, but is gradually becoming more common. The medical name for it is a thoracoscopically assisted oesophagectomy or a minimally invasive oesophagectomy. The surgeon makes 4 to 6 cuts in your abdomen. They use an instrument that is a bit like a bendy telescope (laparoscope). The laparoscope is connected to a fibre optic camera that shows pictures of the inside of the body on a video screen. The laparoscope also has small instruments that fit down the tube. The surgeon uses these to do the surgery while watching what they are doing on the screen.

When the surgeon attaches the remaining section of the oesophagus to your stomach, they may make a larger cut in your abdomen. Or they may continue with using the keyhole technique (laparoscopically).

Laparoscopic surgery takes longer than the more common ways of removing the oesophagus (open surgery). It takes between 8 and 10 hours. In a small number of cases the surgeon needs to switch to open surgery during the operation, and makes a larger wound. Laparoscopic surgery may cause less pain and the recovery time may be quicker compared to open surgery.

 

Removing lymph nodes

During your operation the surgeon will examine the oesophagus and surrounding area. They will take out some of the lymph nodes from around your oesophagus. This is called lymphadenectomy. The surgeon takes out lymph nodes because they may contain cancer cells that have broken away from the main cancer. Taking them out reduces the risk of your cancer coming back in the future. The lymph nodes are sent to the laboratory to be checked. This will help your doctor work out the stage of your cancer. The stage helps to decide which treatment is best for you.

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Updated: 14 April 2014