Oesophagectomy

An oesophagectomy is performed to remove a tumour of the oesophagus or the junction between the oesophagus and stomach, along with the lymph nodes to which this cancer tends to spread first.

The procedure is performed under general anaesthetic and usually performed using an open technique. This is done via an incision down the middle or across the top of the abdomen and a separate incision on the right side of the chest. Often keyhole surgery is used for a portion of this surgery.

First the surgeon will ensure the tumour has not spread outside of the oesophagus and nodes that are being removed. Assuming that this is all ok, the surgeon will proceed to perform the oesophagectomy.

The stomach is freed up from most of the blood vessels that enter it to allow it to freely move up towards the chest. It is then narrowed down using a series of surgical stapling devices into a long tube that can replace the oesophagus once it is removed. The upper part of the stomach near the tumour is removed along with the lymph nodes that are nearby to ensure that the whole cancer is removed.

The tumour is usually close to the point here the oesophagus passes from the chest, through the diaphragm into the abdomen and this area is freed up from the diaphragm to allow it to come free. A pyloromyotomy or pyloroplasty is performed. This is where the muscle that controls the outflow from the stomach into the small bowel is disrupted to make sure food can pass freely through. A plastic surgical drain is placed and brought out through the skin and the abdomen is closed.

The team then carefully reposition the patient to perform a thoracotomy (operation on the chest). An incision is made below the right shoulder blade and between the ribs to access the oesophagus. The lung is deliberately collapsed by the anaesthetist and the oesophagus is found in the chest cavity. The oesophagus is removed along with all of its lymph nodes and the stomach is dragged up into the chest to join onto the part of the upper stomach which has been left behind. One or two plastic drains are placed in the chest and brought out between the ribs before the lung is reinflated and the wound closed with surgical sutures.

In some instances, the surgeon needs to remove more of the oesophagus and so the stomach is actually brought all the way through the chest up to the neck, where an additional incision is made to join onto the oesophagus up in the neck area.

Following an oesophagectomy the patient is admitted to the intensive care unit (ICU) afterwards. You will wake up with a tube coming out of your nose which keeps the join deflated. There may be a surgical drain coming through the abdominal wall and there may also be a feeding tube coming through the abdominal wall. There will also be a drain coming out of your chest. You will also have a catheter in your bladder. You may have a central venous cannula going into one of the main veins in your neck.’

Your diet is restricted for the first week or so to allow the join to heal safely. Over the next week, the various drainage tubes will gradually be removed, and you will make your way from ICU to the normal ward.

After about a week there is usually a contrast x-ray test to confirm that the join is not leaking, and that fluid passes through normally. After this, you will be gradually allowed to drink fluids, then purees and soft foods in a progressive fashion.

Most people spend around 10 – 14 days in hospital and go home once all of the drains have been removed and you are eating or at least drinking normally.

Your surgeon will see you in the office around one month following your surgery. By this time, you should feel well on the road to complete recovery. There may be a need for further cancer treatment with chemotherapy depending on whether cancer was the reason for your oesophagectomy and what the pathologist has found.

This appointment is an opportunity to further discuss your pathology results and how you are progressing since you left hospital.