Surgery to remove your oesophagus

Surgery to remove your food pipe 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 the part of the oesophagus containing the cancer
• a total oesophagectomy - your surgeon removes your whole oesophagus
• an oesophago-gastrectomy – your surgeon removes the top 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.

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

Operations to remove oesophageal cancer are major surgery. You have them under general anaesthetic. You will be asleep for the whole operation.

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

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). The procedure is called an endoscopic mucosal resection (EMR).

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 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 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 remove nodes from around your stomach as well.

How your surgeon does your operation

To remove cancer of the oesophagus you might have:

• open surgery
• keyhole surgery
• a combination of keyhole and open surgery

Open surgery

Your surgeon can make a 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. 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 tummy (abdomen) 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

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

• thoracoscopically 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  

Having keyhole surgery

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 either continue with the keyhole surgery to your chest or do an open operation to remove the cancer and join the remaining stomach to the remaining oesophagus.

Laparoscopic surgery takes between 5 to 7 hours. This is longer than the more common ways of removing the oesophagus (open surgery).

Combining keyhole and open surgery

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

• hybrid minimally invasive oesophagectomy
• laparoscopically assisted oesophagectomy

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

UK guidelines for keyhole surgery

The National Institute for Health and Clinical Excellence (NICE) 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

There isn't enough evidence to say which type of operation is best. So your specialist might recommend either approach for you.