An oesophagectomy is an operation to remove part or all of the oesophagus (gullet).
The oesophagus is the muscular tube that moves food from the throat to the stomach.
An oesophagectomy is mostly performed to treat cancer of the oesophagus.
An oesophagectomy is performed under general anaesthesia. Most patients will be hospitalised for about ten days.
1. Trans-thoracic oesophagectomy
Two incisions are made, one in the right chest and the other in the upper abdomen. The stomach is fashioned into a tube to replace the oesophagus which will be removed. The remaining oesophagus will be joined to the ‘refashioned’ stomach in the chest.
2. Transhiatal oesophagectomy
Two incisions are made, one in the neck and the other in the upper abdomen. The stomach is fashioned into a tube to replace the oesophagus which will be removed. The remaining oesophagus will be joined to the stomach tube in the neck.
3. Three-stage oesophagectomy
Three incisions are made, one in the neck, one in the right chest and the other in the upper abdomen. The stomach is fashioned into a tube to replace the oesophagus which will be removed. The remaining oesophagus will be joined to the stomach tube in the neck.
In selected cases, the operation can be performed with small "keyhole" incisions in the abdomen and chest.
The advantages of a minimally invasive approach are less postoperative pain, and better cosmetic results.
Patients may be admitted to the Intensive Care Unit (ICU) for 1 to 2 days immediately after surgery.
A thin tube may be inserted through the nose into the stomach during the operation. This nasogastric tube will usually be kept in place for a few days after the operation. The patient will also have a urinary catheter. A chest tube to drain fluid may be present.
Initially, the patient will be kept fasted immediately after the surgery. Once better, the patient will be gradually started on oral feeding and advanced from liquids to soft foods.
Pain medication will be given intravenously at the beginning and converted to oral form when the patient can take orally.
The patient will also be encouraged to get out of bed and walk around soon after surgery.
After discharge, the patient can perform light activity for the first 4 to 6 weeks.
The patient should also watch out for:
- Fever or chills
- Abdominal swelling
- Severe pain
- Cough or shortness of breath
- Purulent drainage (pus) or from any incision
- Inability to eat or drink
Dietary adjustments are usually necessary after an oesophagectomy. Such changes may include smaller and more frequent meals (up to 6 meals per day).
Risks for any general anaesthesia are:
- Allergic reactions to medications
- Breathing problems
Risks for any major surgery include:
- Infection in the surgical wound,
- Chest infection (pneumonia)
- Urinary tract infection
- Blood clots in the legs (Deep Vein Thrombosis) that may travel to the lungs
- Heart attack
Risks specific to major oesophagectomy surgery include:
- Injury to the stomach, intestines, lungs, or other organs during operation
- Leakage of the contents of the oesophagus or stomach where they are joined together
- Narrowing of the connection between the stomach and oesophagus