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Saturday, May 10, 2008

Surgery for oesophageal cancer

Your doctor will discuss with you the most appropriate type of surgery. This will depend on the size and position of the tumour, and whether or not it has spread. It is important to discuss any operation fully with your doctor before it happens. You may find it helpful to make a list of any questions you have ahead of the discussion.

Remember, no operation or procedure will be done without your consent. Some types of surgery may mean that you need to stay in hospital for a few weeks.

The operation

The most common type of operation is where the section of the oesophagus containing the tumour is removed and the remaining length of oesophagus is re-attached to the stomach.

There are two main ways of doing this:

  • Trans-thoracic oesophagectomy – cuts are made in the abdomen and the chest so that the affected part of the oesophagus can be removed.
  • Trans-hiatal oesophagectomy – cuts are made in the abdomen and neck to remove the affected part of the oesophagus.

During these operations the top part of the stomach is often also removed. You will still be able to eat in the same way as before, but as the stomach will be higher than before (above the sheet of muscle which divides the chest from the abdomen instead of below) you will need to have smaller meals, more often. You may also find that you feel sick if you eat too quickly.

If it is not possible to join your stomach to the remaining part of the oesophagus, it may be possible to remove a section of your large bowel (colon) to replace the part of the oesophagus that has been removed. If your doctor suggests this type of surgery, they will explain in more detail what is involved.

During your operation the surgeon will check the area around the oesophagus. They will also remove some of the lymph nodes. This is called lymphadenectomy and is done because the nodes may contain cancer. The lymph nodes will be examined under a microscope. Removing them helps to reduce the risk of the cancer coming back as well as helping the doctors to know the stage of your cancer.

Occasionally, the surgeon discovers that the tumour cannot be removed, after a planned operation to remove the cancer has begun. This may be because the tumour has spread or gone through the wall of the oesophagus, or because many lymph nodes are affected. If this happens, the surgeon may insert a tube (stent) instead, to make eating and swallowing easier for you.

After your operation

Most people will be nursed in the intensive care or high-dependency unit for a day or two. This is purely routine and does not mean your operation has gone badly or that there are complications. A machine called a ventilator may be used to help you to breathe – again, this is routine in some hospitals.


It is likely that you will have some pain and discomfort after the operation. You will be given regular painkillers, but should let your nurse or doctor know if you are still in pain. You may have your pain controlled using an epidural. This is a fine plastic tube that is inserted into the space around your spinal cord so that a drug can be given to numb the nerves. Your doctor or nurse will explain this procedure to you.

Drips and drains

A drip will be used to give you fluids until you are able to eat and drink again. You may also have a naso-gastric (NG) tube. This is a fine tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don't feel sick. This helps the area of the operation to recover. You will have chest drains in place for a few days. These are tubes that are inserted into your chest during the operation to drain away any fluid that may have collected around the lungs. The fluid drains into a bottle beside your bed. The chest drains can be uncomfortable; if they are, let your doctor or nurse know.

A physiotherapist will help you to clear your lungs of any fluid that may have built up as a result of your operation.

After your operation, you will be encouraged to start moving around as soon as possible. This is an essential part of your recovery. Even if you have to stay in bed, it is important to do regular leg movements to prevent blood clots forming in your legs, and deep breathing exercises to help keep your lungs clear. A physiotherapist and the ward nurses will help you with this.

Eating and drinking

At first you will not be able to drink fluids, and will only be allowed sips of liquid, until your doctor is satisfied that the join in the oesophagus is healing. It will be a few days before you are able to drink. Some surgeons will put a small feeding tube directly into the small bowel during surgery so that you can be fed through this while you are not able to eat or drink. The tube is put into the middle part of the small bowel (the jejunum) through a small cut made in the wall of the abdomen (tummy). It is usually removed after you have begun to swallow again normally.

You may feel afraid to swallow for a short while and may have a bad taste in your mouth. Mouthwashes can help relieve the bad taste. Gradually, you will be able to eat and drink fairly normally again. It is likely, however, that you will lose quite a lot of weight in the first few weeks after your operation. Try not to worry about it – the weight loss is normal and should slow down once you begin eating well again. The weight loss does not mean that your cancer has come back – few people return to the weight they were before the operation.

You may also have some diarrhoea for a while after the operation, which can usually be controlled with medicine if it continues.

Cancerbackup has sections on nutritional support and dietary problems after surgery.

At home

Before you leave hospital you will be given an appointment to attend an outpatient clinic for your post-operative check up. This will be a good time to discuss any problems you have after your operation. But remember, you can usually ring your hospital doctor, specialist nurse or ward nurse any time if you have problems.

Via: http://www.cancerbackup.org.uk

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