What is Oesophagectomy
Oesophagectomy means removing the oesophagus, or gullet. This is usually done for patients with established esophageal cancer. We offer this service.
This page is about having the surgery for another reason – pre-cancer or early cancer.
Until recently, oesophagectomy was also routinely recommended for people with the pre-cancerous change, high grade dysplasia (HGD) or early cancer arising as a complication of Barrett’s oesophagus.
The new British Society of Gastroenterology guidelines, published in 2013, have, for the first time, suggested that this is no longer first line treatment. Instead, people should first be offered minimally invasive ablative therapies such as HALO radiofrequency ablation (RFA) first. This treatment has a success rate of over 80% in patients with early cancer or high grade dysplasia.
This means, of course, that up to 20% of patients are not cured with HALO RFA. These people should still be considering surgery.
Is surgery right for you?
No one wants to have an operation, particularly if it is a big one. This type of surgery is major. Most people have to stay in the intensive care unit for a few days after surgery and return home after a couple of weeks. It can take around 9 months to return to full health after the operation, so it is not undertaken lightly.
But, if you have early cancer or high grade dysplasia, which is the stage before cancer, then surgery might be right for you.
Of course, it is worth being sure that minimally invasive therapy is not the best option for you before embarking on an operation. But if you have done this, or this treatment has not worked for you, surgery can offer a good solution.
The crucial questions are:
- Do you have the right abnormality?
- Are you fit enough to withstand surgery?
- Are you going to a surgeon who has an excellent safety record?
Surgical risks
Until a few years ago, one in 20 people would die as a direct result of this operation. Things have improved dramatically now in specialist centres, and for HGD, the likelihood of dying as a result of the surgery is much much lower now, around 1 in 100.
The questions are whether your surgeon does this procedure regularly and what the complication rates are. Feel free to ask him or her! The mortality rate of oesophagectomy and gastrectomy for surgeons in the UK were published for the first time this year, and will be updated regularly. You may see them at<
It is also important to carefully assess the patient’s fitness. We offer extensive and careful pre-operative tests including ECG, blood tests and CPEX (cardiopulmonary exercise testing) to ensure that you are fit enough to have this type of operation.
What to expect after surgery
You will be well looked after. The consultant and other members of the surgical team will see you before and every day after surgery. You may need to stay in the Intensive Care Unit or High Dependency Unit for a few days after the operation to ensure that all your bodily functions return to normal. You will then stay in the ward until you feel strong enough to go home.
The biggest change after surgery is eating patterns. Your stomach will be used to replace the part of the oesophagus that is removed. This means that you will have less stomach available to store food. You will have to learn to eat smaller meals more often. You will also almost certainly lose some weight, which you may not regain. You will feel tired initially, but that will pass with time and your eating will also improve over the first few months.
By the first anniversary of the surgery, you can expect to be eating normally and feeling as good as you did before the operation.
If you would like more details on what happens and what to expect after oesophagectomy for HGD and early oesophageal cancer, please feel free to make an appointment with us on 020 7183 7965.
