Surgery to remove oesophageal cancer

If it is possible to try to cure your oesophageal cancer, your surgeon will remove part of your oesophagus. How much the surgeon takes away depends on where in the oesophagus the cancer is. There are various possible operations used to try to remove oesophageal cancer completely. These operations are major surgery. They are all done under general anaesthetic. So you will be asleep for the entire operation.

If the cancer has spread to your stomach, you will need to have the upper part of your stomach removed, as well as the affected part of the gullet. This is called an oesophago-gastrectomy.

You may have the part of your oesophagus that is cancerous removed and the healthy part reattached to your stomach, which the surgeon pulls up into the chest.

Sometimes, the surgeon may prefer to use a bit of bowel to replace the part of the oesophagus that has been taken out instead of joining the oesophagus directly to the stomach.

You may need to have the whole of your oesophagus taken out. This operation is called a total oesophagectomy. The surgeon will pull the stomach up into the chest and use it to replace the oesophagus.

Sometimes, the surgeon may have to take a piece of the large bowel (colon) and use that to replace the oesophagus. You will have an abdominal scar after a total oesophagectomy.

There are different ways of doing these operations on the gullet. Your surgeon can approach the cancer via your neck, chest or tummy (abdomen). Which is suitable depends mainly on where your cancer is in your oesophagus. It may also depend, to some extent, on whether your surgeon prefers one type of operation or another. You may hear the terms 'trans hiatal oesophagectomy' or 'trans thoracic oesophagectomy'. This just describes the surgeon's approach. The operations are also sometimes named after the surgeon that developed them. Trans thoracic oesophagectomy is sometimes called an Ivor Lewis operation, for example.

Depending on which operation you have, you may have

• A scar on your tummy (abdomen)
• A chest scar, on the right or left
• A neck scar

Or you could have a combination of these.

Keyhole surgery to remove the oesophagus is still quite new, but is gradually becoming more common. The medical name for it is a 'thoracoscopically assisted oesophagectomy' or a 'minimally invasive oesophagectomy'. The surgeon makes 4 to 6 cuts in your abdomen (tummy) and does the operation using a camera and instruments that can be put inside your body through these cuts. It takes longer than a standard, open, oesophagectomy, but we hope that it will cause less pain and complications for people after surgery. There is more information about keyhole surgery for oesophageal cancer on the what's new page in this section.

During your operation the surgeon will examine the oesophagus and surrounding area. He or she will take out some of the lymph nodes from around your oesophagus. This is called lymphadenectomy. The surgeon takes out lymph nodes because they may contain cancer cells that have broken away from the main cancer. Taking them out reduces the risk of your cancer coming back in the future. The lymph nodes will be sent to the laboratory and checked. This will help your doctor work out the stage of your cancer. And the stage helps to decide which treatment is best for you.