The removal of the oesophagus for cancer is a major operation. There are a number of approaches depending on the type of cancer and its location. These will be discussed with you.
Surgery will usually be preceded and followed by combination chemotherapy.
After preoperative chemotherapy, re-staging the cancer and assessing the fitness of the patient, a patient will usually be offered an Ivor Lewis oesophagogastrectomy. This operation is in two phases under the same anaesthetic. Phase 1 involves opening the abdomen to prepare the stomach to bridge the gap, remove local lymph nodes, improve stomach emptying, tying off the thoracic duct and insert a feeding tube into the small bowel. Phase 2 involves entering the right chest through an incision under the arm. The part of the oesophagus with the cancer and associated lymph nodes are removed and the stomach is brought up into the chest and attached to the remaining oesophagus.
Major surgery like this can be associated with complications of some sort or another in about 50% of patients, and there is a small risk of mortality. Routine precautions are taken for general complications such as pneumonia, wound infection, urinary infection and blood clots (DVT). The surgeon is most concerned about a leak from the join between the stomach and the oesophagus. Again precautions are taken, including the placement of drains. If a leak occurs it may require further surgery, but in most cases this is not required.
This operation usually means 10-14 days in hospital, with the first 24 hours in the intensive care unit. Recovery can take many weeks and is usually interrupted by the resumption of chemotherapy.