Surgery for cancer of the esophagus
For some early stage cancers, surgery is used to try to remove the cancer. Sometimes, it might be combined with other treatments, such as chemotherapy or radiation. How much surgery is done depends on the stage of the cancer. You and your surgeon should discuss the planned operation and what you can expect in detail.
Surgery to remove all or part of the esophagus is called an esophagectomy. Often a small amount of the stomach is taken out, too. The top of the esophagus is then reattached to the stomach, or the surgeon may replace the removed part of the esophagus with a piece of intestine. There are different ways to do an esophagectomy, but all of them are complex.
In a standard, open esophagectomy, the surgeon operates through one or more large cuts (incisions) in the neck, chest, or abdomen. The main incision is often in either the chest or the belly (abdomen).
Minimally invasive esophagectomy
For some early (small) cancers, the esophagus can be removed through several small incisions. The surgeon puts a scope (like a tiny telescope) through one of the incisions to see everything during the operation. Then long, thin surgical instruments go in through other small incisions. To do this type of surgery well, the surgeon needs to be highly skilled and have a great deal of experience removing the esophagus this way. When successful, this surgery allows the patient to leave the hospital sooner and recover faster.
No matter which approach is used, esophagectomy is not a simple operation, and it may require a long hospital stay. Surgeons who do this surgery must be experts. Ask your surgeon how many of these operations he or she has done and how many were successful. It is very important to have this surgery done at a center that has a lot of experience treating these cancers.
If the cancer has not yet spread far beyond the esophagus, taking out the esophagus might cure the cancer. But most esophageal cancers are not found early enough for doctors to cure them with surgery, so it’s important to know whether the goal of surgery is to try to cure the cancer or to ease symptoms.
Taking out lymph nodes
When some or all of the esophagus is removed, nearby lymph nodes are removed too. These are then checked to see if they have cancer cells. If the cancer has spread to lymph nodes, the outlook is not as good, and the doctor may recommend other treatments after surgery.
Risks and side effects of esophagectomy
Like most major operations, surgery of the esophagus has some risks. These risks include reactions to anesthesia, excess bleeding, blood clots in the lungs or elsewhere, and infections. Most people will have at least some pain after the operation, which can often be helped with medicines.
Lung problems are common. Some people may get pneumonia, leading to a longer hospital stay, and sometimes even death.
Some people might have voice changes after the surgery.
There may be a leak at the place where the stomach (or intestine) is attached to the esophagus, which could mean more surgery to fix it.
Sometimes the esophagus narrows, which causes trouble swallowing after surgery. To relieve this symptom, these narrow places can be stretched during an upper endoscopy.
After surgery, the stomach may empty too slowly. Sometimes this can lead to frequent nausea and vomiting.
After surgery, bile and stomach contents can get into the esophagus because the muscle that normally controls this (the lower esophageal sphincter) is often removed or changed by the surgery. This can cause heartburn and other symptoms. Sometimes antacids or other drugs can help relieve these symptoms.
Some complications from surgery can be very serious, even fatal. It is important to have a surgeon with experience and a hospital where these operations are done often. Don’t be afraid to ask the surgeon about his or her experience and about the survival rates at the hospital.
For more general information about surgery as a treatment for cancer, see A Guide to Cancer Surgery.
Surgery as palliative care
Sometimes minor types of surgery are used to help prevent or relieve problems caused by the cancer, instead of trying to cure it. For example, minor surgery can be used to put a feeding tube directly into the stomach or small intestine for people who need help getting enough nutrition.
Last Medical Review: 05/21/2014
Last Revised: 02/04/2016