Having your oesophageal cancer operation

Before your surgery, you will need

• Blood tests to check your general health and kidney function
• A chest X-ray to check your lungs are healthy
• An ECG to check your heart is healthy

You may have had some of these tests while your cancer was being diagnosed. If so, you may not have to repeat them. You may also be asked to have

• Breathing tests (called lung function tests)
• An ECG while you are exercising
• An echocardiogram (a painless test of your heart using sound waves)

These tests are just to make sure you are fit enough to make a good recovery from your surgery.

When you go into hospital for your operation, members of the multidisciplinary team (MDT) looking after you, including your surgeon, anaesthetist, physiotherapist, dietician and specialist nurse will all come to talk to you about what will happen. You may have already met some of them at a clinic appointment some time before you are admitted to the ward. You may have been given the contact details for a key worker, so that you can ask them for advice before and after your operation. Your key worker is usually the clinical nurse specialist. 

Your surgeon will explain what is going to be done and what to expect when you come round from the anaesthetic. Ask as many questions as you need to. It may help to make a list of questions before you go into hospital for your operation. There are some suggestions for questions at the end of this section. The more you know about what is going to happen, the less frightening it will seem. Don’t worry if you think of more questions later. Just speak to your nurses. They can answer your questions or ask the doctor or specialist nurse to come and talk to you again.

Your dietician will discuss any eating problems that you may have. They may give you liquid supplement nutritional drinks to drink before your surgery. They will talk to you about how you can gradually build up eating and drinking after the surgery. You may need to have liquid food into a vein to maintain nutrition before and after the surgery. 

Your physiotherapist or nurse will teach you breathing and leg exercises. You can help yourself to get better by doing these exercises after your operation. You should do them as often as you are told you need to. Breathing exercises will help to stop you getting a chest infection. And leg exercises will help to stop clots forming in your legs. Both these complications of surgery can happen because you are not moving around as much as you would normally. Your nurses will encourage you to get up and about as soon as possible after your operation. But this is major surgery and you may have to stay in bed for the first couple of days.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.
 

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

If you have been finding eating and drinking difficult, your doctor may want you to have a drip (intravenous infusion) put into your arm before your surgery. You can have fluids through this so that you are not dehydrated before your operation.

If you have body hair on your chest or abdomen, you may need a shave before your operation. Shaving can lower the risk of an infection getting into your wound. You may have your shave on the ward, or in the operating theatre while you are under anaesthetic.

If you have had a big operation you will wake up in intensive care or a high dependency recovery unit. This is nothing to worry about. These are places where you can have one to one nursing care. And your surgeon and anaesthetist can keep a close eye on your progress. As soon as your doctors are sure you are recovering well, you will move back to the ward.

When you wake up, you will have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You will have

• Drips (intravenous infusions) to give you blood transfusions, and fluids until you are eating and drinking again
• One or more tubes coming out of your chest or abdomen near your wound
• A tube into your bladder (catheter) so that your urine output can be measured

One of the tubes coming out of your chest may be a chest drain. You will always have one of these after any surgery to the chest. This is because any operation on the chest causes the lung on that side to collapse. The chest drain may be connected to gentle suction. This helps your lung to inflate properly again over the next few days. When your doctor thinks your lung is fully inflated, you will have a chest X-ray. If that is OK, your nurse will take the chest drain out. This is a simple matter of pulling on it gently. Another nurse will be standing by ready to tighten up the stitch around the drain site as soon as the tube comes out.

You may also have a tube coming out of your abdomen. This is to drain blood and fluid away from the operation site and so help it to heal. Sometimes wound drains are connected to collecting bottles or bags. Your nurse will empty these daily and record how much is in them. Your nurse will take the tubes out once they have stopped draining. This is generally a week or so after surgery. Again, they are just gently pulled out.

When you first wake up, you will have a little clip on your finger to measure your pulse and blood oxygen levels. This is called a pulse oximeter. You may also have an oxygen mask on for a while. You will also have a blood pressure cuff around your arm. Your nurse will keep a close eye on your blood pressure for the first few hours after you come round from the anaesthetic. Your nurse will also measure and record you urine output because it can help show whether you have too much fluid or are becoming dehydrated.

You may have a couple of electronic pumps attached to your drips. These are for controlling any medication you might be given through your drip.

You will almost certainly have pain for the first week or so. But there are many different pain killing drugs you can have. It is important to tell your doctor or nurse as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly.

You may have an electronic pump attached to your drip for your painkillers just after surgery. These usually have a hand control, with a button to press to give yourself extra painkillers as you need them. This is called PCA or patient controlled analgesia. Do use it whenever you need to. You can’t overdose because the machine is set to prevent that. Do tell your nurse if you need to press the button very often. You may need a higher dose in the pump.

Some surgeons and anaesthetists prefer to give painkillers into the spine (an epidural) for the first day or so after surgery. This usually works really well. You have a very thin tube put into your back, into the space that surrounds your spinal cord. This is all done while you are under anaesthetic. When you wake up, you will find the tube is taped to your back. It connects to a pump, which gives you a continuous dose of painkiller. Tell your nurse if you are in pain as the dose can be increased.

As you have had surgery to part of your digestive system, you will not be able to eat or drink anything at first. You will have fluids through your drip to keep you hydrated. You may be allowed to moisten your mouth with small sips of water.

You may require help to meet your nutritional needs. There should be a dietician in your multidisciplinary team (MDT). They will be able to give you advice about getting enough nutrition. If you need to be fed through a tube for a time, they will be able to make sure you are getting the right nourishment. You could have a tube inserted through your skin into your small bowel, and be fed through it. This is called a jejunostomy, because it goes into part of the small bowel called the jejunum. It might be necessary to give you nutrition directly into a vein. This is called parenteral nutrition.

About a week after your surgery (perhaps earlier in some hospitals), you will be able to start eating. Because you have had surgery to your oesophagus, you will have to start eating and drinking very gradually at first. You usually start off with sips of clear fluid. If you manage those, the amount you can have will slowly be increased. Then you move on to other drinks such as milk, tea and soup. Once you are able to drink without being or feeling sick, your drip can come out.

Some surgeons like to do a test before allowing you to start eating. This is an X-ray, similar to a barium swallow. It just makes sure there are no leaks where the oesophagus has been stitched to either the stomach, another part of the oesophagus or to a section of bowel. You have to swallow a type of dye called Gastrograffin. The dye shows up any leaks clearly on the X-ray. Some surgeons prefer to do this test just before you go home. Others don't use it at all, unless they are concerned that there may be a leak.

If you have had the lower third of your oesophagus removed, your surgeon will also have taken out the valve at the top of your stomach, (the lower oesophageal sphincter). This valve is there to keep the contents in the stomach away from your oesophagus. After your operation, you may find that you have some acid reflux. Your doctors can give you antacids to relieve this. It will also help to make sure you stay sitting upright for a couple of hours after eating. Your surgeon may advise you not to lie flat in bed, but to sleep propped up on a couple of pillows. And not to bend down with your legs straight. You should lift by squatting down, with your knees bent.

There is a lot of information about managing diet problems in cancer in our cancer section on coping physically with cancer.

The wound will be covered when you come round from the operation. Usually, wounds like this are left covered for a couple of days. Then your nurse will change the dressings and clean the wound. Your stitches or clips will be left in for at least 10 days. Usually these are taken out before you go home. But sometimes, if the wound is not quite healed, but you are otherwise well, you can go home with them in. You can either come back to the hospital to have them taken out, go to your GPs surgery for the practice nurse to do it, or a district nurse will visit you at home and take them out there.

This may seem impossible at first. Moving about helps you to get better, but you will need to start very gradually. Your physiotherapist will visit you every day after your operation to help you with your breathing and leg exercises.

Your nurses will encourage you to get out of bed and sit in a chair one or two days after your surgery. They will help you with all the drips and drains. Over the next couple of days, the tubes, bottles and bags will start to be taken out. Then, it will be much easier to get around.

After a few days you will be up and about more. Gradually you will start to feel better. Soon you will be able to eat more. At first you will find it easier to have lots of very small meals rather than 3 large meals a day. The hospital dietician will give you help and advice with managing your diet.

There is information about diet after oesophageal surgery in the living with oesophageal cancer section of CancerHelp UK.