Oesophagectomy
An oesophagectomy is performed to remove a tumour of the oesophagus or the junction between the oesophagus and stomach, along with the lymph nodes to which this cancer tends to spread first.
The Procedure
The procedure is performed under general anaesthetic and can be performed using either an open, laparoscopic or combination approach. This is done via an incision down the middle of the abdomen and a separate incision on the right side of the chest. Often keyhole surgery is used for a portion of this surgery.
First the surgeon will ensure the tumour has not spread outside of the oesophagus and nodes that are being removed. Assuming that this is all ok, the surgeon will proceed to perform the oesophagectomy.
The stomach is freed up from most of the blood vessels that enter it to allow it to freely move up towards the chest. It is then narrowed down using a series of surgical stapling devices into a long tube that can replace the oesophagus once it is removed. The upper part of the stomach near the tumour is removed along with the lymph nodes that are nearby to ensure that the whole cancer is removed. The tumour is usually close to the point that the oesophagus passes from the chest, through the diaphragm into the abdomen. This area is freed up from the diaphragm to allow it to come free.
The team then carefully reposition the patient to access the chest. An incision is made below the right shoulder blade and between the ribs to access the oesophagus. The lung is deliberately collapsed by the anaesthetist and the oesophagus is found in the chest cavity.
The oesophagus is removed along with all of its lymph nodes and the stomach is dragged up into the chest to join onto the part of the upper stomach which has been left behind. One or two plastic drains are placed in the chest and brought out between the ribs before the lung is reinflated and the wound closed with surgical sutures.
In some instances, the surgeon needs to remove more of the oesophagus and so the stomach is brought all the way through the chest up to the neck, where an additional incision is made to join onto the oesophagus up in the neck area.
Recovery
Following an oesophagectomy the patient is admitted to the intensive care unit (ICU).
You will wake up with a tube coming out of your nose which keeps the join deflated. There may be a surgical drain coming through the abdominal wall and there may also be a feeding tube coming through the abdominal wall. There will also be a drain coming out of your chest. You will also have a catheter in your bladder. You may have a central venous cannula going into one of the main veins in your neck.
Your diet is restricted for the first week or so to allow the join to heal safely. Over the first few days, the various drainage tubes will gradually be removed, and you will make your way from ICU to the normal ward.
Most people spend around 7-10 days in hospital. Patients are discharged either to home or rehab once all of the drains have been removed and you are eating or at least drinking normally.
Follow Up
Dr Gillespie will see you in the office 1-2 weeks following your surgery. By this time, you should feel well on the road to recovery. There may be a need for further cancer treatment depending on whether what the pathologist has found.
This appointment is an opportunity to further discuss your pathology results and how you are progressing since you left hospital.
The Patient Journey
Book an appointment
Call or email Dr Gillespie’s rooms to book an appointment. You will need a referral from your GP or specialist if you would like a Medicare rebate.
First Consult
You'll meet with Dr Gillespie to discuss your symptoms, history and diagnosis.
We encourage bringing a support person to these appointments as there is often a lot of new information discussed.
We also encourage writing down any questions before you attend this appointment.
Work up
Any new cancer diagnosis requires a full workup for staging. Dr Gillespie will discuss what is needed in your specific case and organise any further imaging (eg CT and/or PET), endoscopy or laparoscopy.
Multidisciplinary team meeting
This is a meeting attended by medical oncology, radiation oncology, radiology, gastroenterology, pathology and surgeons. Each case is discussed in detail and a treatment recommendation is agreed upon.
Further appointments
After MDT, Dr Gillespie will generally discuss with you the ongoing plan. You may need to see (or will have already seen) a medical oncologist or radiation oncologist.
Surgery
If you have chemotherapy beforehand, surgery will usually be four weeks after completion.
You will be admitted to hospital for a minimum of 5 days following the procedure.
After discharge
You may need a period of rehabilitation following surgery. This will be organised from hospital.
We will keep a close eye on your nutrition and a dietitian appointment can be organised for you.
Follow up
Dr Gillespie and the oncology team will follow you up closely for two years after your treatment, and then ongoing to five years.
Pathology
Depending on your treatment plan and pathology, further chemotherapy and/or radiotherapy may be required.