Depending on what type of cancer you have, you may be given a course of chemotherapy or radiotherapy before your operation. Your doctor will have a chat with you about your treatment options once your diagnosis has been confirmed.
Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop. Smoking can increase your risk of getting a chest and wound infection, which can slow your recovery.
Before you have an oesophagogastrectomy, your doctor will need to do some tests. These are to make sure the procedure is right for you.
- Endoscopy. This procedure is used to look inside your oesophagus, stomach and the first part of your small bowel (duodenum) using an endoscope. An endoscope is a narrow, flexible, tube-like camera. It allows a biopsy to be taken. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous.
- Barium swallow and meal. This involves swallowing a drink that contains barium (a substance which shows up on X-rays). X-ray images of the upper abdomen (tummy) then show the inside of your oesophagus and stomach more clearly.
- CT or MRI scan. A CT scan uses X-rays to make a three-dimensional image of your body. An MRI scan uses magnets and radio waves to produce images of the inside of your body. They are used to find out the size of your tumour and if the cancer has spread.
To make sure you’re well enough to have an oesophagogastrectomy, your doctor may recommend some further tests. Some of these are listed below.
- Blood tests, chest X-ray and a cardiopulmonary exercise test. A cardiopulmonary exercise test involves running on a treadmill to see how well your heart and lungs work.
- An electrocardiogram. This is a test that records the rhythm and electrical activity of your heart. Your doctor may also ask you to have an echocardiogram, which involves using ultrasound to produce moving images of your heart).
An oesophagogastrectomy is performed under general anaesthesia. This means you will be asleep during the procedure. An anaesthetic can make you sick, so it’s important you don’t eat or drink anything for six hours beforehand. Follow your surgeon’s advice and if you have any questions, just ask.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, as you will be asked to sign a consent form for the procedure to go ahead.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. As well as wearing compression stockings, you may also be given an injection of an anti-clotting medicine such as heparin or tinzaparin.
The length of your procedure can vary depending on which type of operation you have.
An oesophagogastrectomy can be done using either open or keyhole surgery. In an open procedure, your surgeon will make two large cuts into your upper abdomen (tummy) and chest. For a keyhole procedure, your surgeon will make several small cuts instead. The operation is done using special instruments, and viewed through a camera inserted into one of the cuts. Talk to your surgeon about which procedure is most suitable for you.
During the operation, your surgeon will remove the diseased part of your oesophagus and stomach. They will then rejoin the remaining part of your oesophagus to the healthy part of your stomach.
Sometimes your surgeon may attach your oesophagus to your small bowel if your entire stomach needs to be removed. They will also remove nearby lymph nodes to check for cancer cells. This will help to find out if you need any further treatment.
Your surgeon may insert a feeding tube into your small bowel, which is brought to the surface of your skin. This is called a jejunostomy. After your surgery, you’ll be able to have food in the form of liquid through this tube.
After having an oesophagogastrectomy, you’ll be transferred to the intensive care or high dependency ward at first. You might have some discomfort as the anaesthetic wears off. But you'll be offered pain relief as you need it. You may also be offered patient controlled analgesia. This is a pump connected to a drip in your arm that allows you to control how much pain medicine you have.
You may have a catheter (tube) to drain urine from your bladder into a bag. You may also have fine tubes running out from the wound. These drain fluid into another bag while your wound heals.
You will have a drip inserted into a vein in your hand or arm, or into the side of your neck to give you fluids. When you feel well enough, you can start to drink small amounts of water.
When you wake up after the surgery, you’re likely to have a fine tube in one nostril (this is called a nasogastric tube). This will go across the area where your oesophagus and stomach have been joined. You will be encouraged to get out of bed when you feel ready, usually with the help of a physiotherapist. Moving around after your operation can help prevent complications and may help to speed up your recovery. You will also have daily injections to help prevent blood clots.
You will usually be able to go home four to eight days after your operation. Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.
Before you go home, you will see your surgeon so you can discuss how the procedure went and any further treatment you might need. Your nurse will advise you about caring for your healing wounds and may arrange a date for a follow-up appointment.
The amount of time it takes to make a full recovery from an oesophagogastrectomy varies from person to person. It’s important to follow your surgeon’s advice. If you had a keyhole procedure, your recovery may be slightly faster.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You’ll need to make some changes to your diet after your procedure. For example, you’ll only be able to eat small amounts of food at each meal. Before you go home, you’ll be given advice on how to eat well while you recover. To begin with, you’ll need to eat foods that are very soft. Your dietitian or surgeon will explain how to start eating solid foods again. You may also be asked to take vitamin and mineral supplements to help your recovery.
As with every procedure there are some risks associated with oesophagogastrectomy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. For example, you may feel sick as a result of the general anaesthetic.
You may have some pain after your procedure. You may also have a dry cough and diarrhoea for the first few months afterwards.
Depending on what type of operation you had, you may have a scar on your chest, abdomen (tummy) or neck. Although your scar may be slightly raised and swollen at first, this should gradually settle over time.
Complications are when problems occur during or after the procedure. Complications of oesophagogastrectomy can include the following.
- Leakage. This is the most serious complication. If the join leaks, you may need further surgery.
- An infection called mediastinitis, which can cause severe chest pains and fever. This can happen if there’s a tear in your oesophagus. Mediastinitis can be treated with antibiotics or further surgery.
- Narrowing of the new join. The join may need gentle stretching to reopen it using an endoscope (a flexible tube-like camera).
- Heartburn (acid reflux). An oesophagogastrectomy involves removing the valve at the lower end of your oesophagus. This means you will no longer have a barrier to stop the acidic contents of your stomach pushing up into your oesophagus. When this happens, it causes a burning sensation in your chest (known as heartburn). You can help prevent this by sleeping propped up and not eating late in the evening.
Will I need to change my diet after I’ve had an oesophagogastrectomy?
Yes, you may need to change your diet as some foods can cause problems with your digestive system. It’s worth bearing in mind that it may take a few months for your stomach to get back to normal. You will usually be seen by a dietitian after your procedure who will give you advice about how to eat well while you recover.
For the first two or three weeks after your procedure, you’ll need to eat food that is very soft. This will help the new join between your stomach and oesophagus heal. You may be given advice about what to eat by a dietitian. For example, you may be advised to follow a diet that’s high in protein and take vitamin supplements to help your recovery.
Then, in the following few months, you’ll be able to eat small portions regularly throughout the day, rather than one big meal. Small portions will be easier for your stomach to manage and will reduce your risk of heartburn (acid reflux).
Talk to your surgeon or dietitian for more information about the foods you can eat after your procedure.
How soon can I do physical activity after I’ve had an oesophagogastrectomy?
Recovering from an oesophagogastrectomy can take some time. You will need to take things slowly for the first few weeks and build up the amount of physical activity you do gradually.
Oesophagogastrectomy is a major operation and you will need to take it easy for a while. Following your procedure, you will need to rest in bed. On the second or third day, you’ll be encouraged to get up and sit in a chair. Over the next few days your physiotherapist will show you some exercises to do. It’s important to do these exercises as they will help your recovery and improve your strength.
At home as you recover, you can begin to do some walking. Start by walking just around the house and then gradually increase the distance. But it’s important not to push yourself.
Don’t do any activities that involve holding your breath, such as heavy lifting, for at least six weeks after your operation.
When can I return to work after I’ve had an oesophagogastrectomy?
The exact amount of time you will need to have off work will be specific to you. This is because it not only depends on your recovery from the procedure, but also on the type of work you do.
The amount of time you will need to take off work will depend on a number of different factors. These include your age, the type of work you do and how well you recover after the procedure. Other factors include your general health and whether you’re having any further treatment, such as chemotherapy or radiotherapy.
You’re likely to be off work for several months and you shouldn’t go back until your surgeon or doctor tells you it’s safe to do so. When you do return, you may find you get tired easily, so it’s important to take regular breaks. It’s important to let your employer know about your treatment, as you may need to arrange some time off for further treatments or check-ups.
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