Surgical Oesophagectomy for Barrett’s Dysplasia

Jun 3, 2024

Why Oesophagectomy?

Oesophagectomy means removing the oesophagus, or gullet. This is usually done for patients with established esophageal cancer. This blog is about having the surgery for another reason – pre-cancer or early cancer.

Until less than 15 years ago, oesophagectomy was 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  British Society of Gastroenterology guidelines, published in 2013, changed this because, for the first time they recommended that surgery is no longer first line treatment. Instead, people should first be offered minimally invasive ablative therapies such as 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 might still be considering surgery.

Is surgery right for you?

Nobody 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 endoscopic 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.

Have you Considered Cryoablation?

One of the newest interventions for minimally invasive treatment is freezing the abnormality. Our extended team has now done this many times in patients who have not been cured with radiofrequency ablation. It is worth considering this endoscopic approach before committing yourself to surgery.

The crucial questions to discuss with your doctor 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?

Minimising Surgical Risks

Surgery continues to become safer and less invasive.

(Please note that although we can refer you to suitable surgeons, we do not perform surgery at the London Gastroenterology Centre.)

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 (death) rate of oesophagectomy and gastrectomy for surgeons in the UK are now published. You can find out information about your surgeon’s performance from the Private Healthcare Information Network (click on the link).

It is also important to carefully assess the patient’s fitness. The surgeon should 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 if you have surgery done at one of London’s top private hospitals.

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 more or less normally and to be feeling well again.

We are available to see patients daily for private consultations

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