Find out about the different types of surgery for oesophageal cancer.
What type of surgery do I need?The type of surgery you need for cancer of the oesophagus (food pipe) depends on
- the size of the tumour
- where it is in your oesophagus
Operations to remove oesophageal cancer are major surgery. You have them under general anaesthetic. You will be asleep for the whole operation. You may need to travel to a specialist centre to have your surgery.
Most people need to have all or part of their oesophagus removed. For very small, early cancers your doctor may be able to remove the lining of your oesophagus. Your surgeon removes this using a long flexible tube (endoscope). The procedure is called an endoscopic mucosal resection (EMR).
Removing part of the oesophagus and part of the stomach
Your surgeon will remove the top third of your stomach and part of your oesophagus if the cancer has grown into your stomach. This is an oesophago gastrectomy.
Removing part of your oesophagus and reattaching it to your stomach
This operation is for when the cancer is only in the oesophagus. The surgeon removes the cancer and some surrounding healthy tissue. They then rejoin the healthy part to your stomach and pull it up into the chest.
Your surgeon may use part of your bowel to replace the part of oesophagus they removed. This is instead of joining the oesophagus to the stomach. Surgeons don’t do this operation very often.
Removing all of your oesophagus
You may need to have the whole of your oesophagus taken out. This operation is a total oesophagectomy.
Your surgeon uses your stomach or more rarely a piece of your bowel to replace the part of the oesophagus that they remove.
When they use the stomach to replace the oesophagus the surgeon pulls your stomach up into your chest.
Removing lymph nodes
During your operation the surgeon examines the oesophagus and surrounding area. They take out all of 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. It also helps your doctor to decide if you need chemotherapy after your surgery.
The number of lymph nodes your surgeon removes varies. Your surgeon might remove nodes from around your stomach as well.
How your surgeon does your operation
To remove cancer of the oesophagus you may have open surgery or keyhole surgery. Most people have open surgery.
Your surgeon can make a cut into your neck, chest or tummy (abdomen). They make 2 cuts to reach the oesophagus.The type of surgery you have depends on where the cancer is in your oesophagus. It also depends to some extent on which your surgeon prefers. The types are
- trans hiatal oesophagectomy, which means having the operation through a cut in your abdomen (tummy) and neck
- trans thoracic oesophagectomy, which is when the surgeon makes cuts in your abdomen and chest
Trans thoracic oesophagectomy is sometimes called an Ivor Lewis operation, 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.
Keyhole surgery to remove the oesophagus is still quite new. The medical name for it is a thoracoscopically assisted oesophagectomy, or you may hear the term minimally invasive oesophagectomy.
You have this type of surgery in specialist centres by a specially trained surgeon.The surgeon makes 4 to 6 cuts in your abdomen. They use a long, bendy tube called a laparoscope.
Having keyhole surgery
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 either continue with the keyhole surgery or do an open operation to remove the tumour and join the remaining stomach to the remaining oesophagus.
The cut with open surgery is usually in the chest (thoracotomy), on your side.
Laparoscopic surgery takes between 8 and 10 hours. This is longer than the more common ways of removing the oesophagus (open surgery).
UK guidelines for keyhole surgery
The National Institute for Health and Clinical Excellence has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the oesophagus but they must
- tell people having the surgery about the risks and benefits
- monitor people closely
- collect information about any problems people have and report on them
Researchers are looking into whether keyhole surgery is as good as open surgery.