Surgery to remove your oesophagus

Surgery to remove your food pipe (oesophagus) is called an oesophagectomy. There are different types of oesophagectomy. The type you have depends on the stage and position of your cancer. 

You might have:

• an oesophagectomy – your surgeon removes all or part of the oesophagus
• an oesophago-gastrectomy – your surgeon removes the top part of your stomach and the part of the oesophagus containing cancer

Your surgeon also removes some of the nearby lymph nodes. This is called a lymphadenectomy or lymph node dissection. It helps to reduce the risk of cancer coming back.

You might need to travel to a specialist centre to have your surgery.

What type of surgery do I need?

The type of surgery you need for cancer of the oesophagus depends on:

• the size of your cancer
• where it is in your oesophagus

An operation to remove oesophageal cancer is major surgery. You have it under general anaesthetic, so you are in a deep sleep.

Most people need surgery to remove all or part of their oesophagus. For very small, early cancers your doctor might be able to remove the lining of your oesophagus. Your surgeon removes this using a long flexible tube (endoscope). You might have an endoscopic mucosal resection (EMR) or an endoscopic submucosal dissection (ESD).

Removing all or part of your oesophagus

If your cancer is in the top or middle part of your oesophagus you might have all or part of your oesophagus removed. This is called an oesophagectomy. 

The surgeon removes the cancer and some surrounding healthy tissue. They pull your stomach up into the chest and rejoin it to the healthy part of your oesophagus. 

Rarely your surgeon might not be able to use your stomach to join to the oesophagus. They may then use part of your bowel to replace the part of oesophagus they removed. 

Removal of part of your oesophagus

Removal of all of your oesophagus

Removing part of the oesophagus and part of the stomach

Your surgeon might remove the top part of your stomach and part of your oesophagus. This is an oesophagogastrectomy.

This happens if the cancer is in the middle or bottom part of your oesophagus, or it has grown into your stomach. 

The surgeon removes the cancer and some surrounding healthy tissue. They pull the rest of your stomach up into the chest and rejoin it to the healthy part of your oesophagus.  

Removing lymph nodes

During your operation the surgeon examines the oesophagus and surrounding area. They take out the lymph nodes from around your oesophagus. This is a lymphadenectomy.

The surgeon takes out lymph nodes in case they contain cancer cells that have spread from the main cancer. Taking the nodes out reduces the risk of your cancer coming back in the future. 

The number of lymph nodes your surgeon removes varies. Your surgeon might also remove nodes from around your stomach.

How your surgeon does your operation

To remove cancer of the oesophagus you might have:

• open surgery
• keyhole (laparoscopic) surgery
• a combination of keyhole and open surgery

The multidisciplinary team (MDT) will discuss the best option for you.

Open surgery

Open surgery means the surgeon makes a larger cut into your neck, chest or tummy (abdomen). They make 2 or 3 cuts to reach the oesophagus.

The type of surgery you have depends on where the cancer is in your oesophagus. The types are:

• transhiatal oesophagectomy, which means having the operation through a cut in your tummy and neck
• transthoracic oesophagectomy, which is when the surgeon makes cuts in your tummy and chest

Trans thoracic oesophagectomy is sometimes called an Ivor Lewis operation. This is named after the surgeon who first did the operation.

Depending on which operation you have, you may have a:

• scar on your abdomen
• chest scar, on the right or left which goes round towards your back underneath the shoulder blade
• neck scar

Or you could have a combination of these. Ask your surgeon about your scars if this is something you want to know. It might help you prepare if you know what to expect.

Keyhole surgery

Keyhole surgery has different medical names. You might hear it called:

• laparoscopically assisted oesophagectomy
• minimally invasive oesophagectomy

You have this type of surgery in specialist centres by a specially trained surgeon.

The surgeon uses a thin, flexible tube with a light and a camera (thoracoscope or laparoscope) to look inside and operate on your body. They use a:

• thoracoscope, to look inside and operate on your chest
• laparoscope, to look inside and operate on your tummy  

The surgeon makes 4 to 8 cuts in your tummy. The laparoscope connects to a fibre optic camera. This shows pictures of the inside of the body on a video screen. The surgeon then uses the other incisions to put the other instruments they use to do the surgery into your body.

Using the laparoscope and other instruments, the surgeon frees the stomach so they can move it into the chest. They then continue with the keyhole surgery to your chest, Or they do an open operation to remove the cancer and join the remaining stomach to the remaining oesophagus.

Combining keyhole and open surgery

Sometimes surgeons combine keyhole and open surgery, You might hear this called:

• hybrid minimally invasive oesophagectomy
• thorascopically assisted oesophagectomy

You have keyhole surgery to your tummy, using a laparoscope. And then the surgeon continues the operation using open surgery.