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Oesophagogastrectomy
Expert reviewer, Mr Stephen Pollard, Consultant Surgeon
Next review due December 2022
An oesophagogastrectomy is an operation to remove the top part of your stomach and bottom part of your oesophagus. You may need this operation if you have cancer at the place where your stomach and oesophagus join together.
About oesophagogastrectomy
Your oesophagus is the pipe that goes from your mouth to your stomach. If you have cancer of the oesophagus, you may need to have surgery to remove part or all of your oesophagus. This will depend on where exactly your cancer is and how much it has spread.
If the cancer has grown into your stomach as well, you’ll need to have an oesophagogastrectomy. During this procedure, your surgeon will remove part of your stomach as well as part of your oesophagus. Before you have an oesophagogastrectomy, your specialist doctor will need to do some tests to make sure the procedure is right for you.
Checking you’re fit for surgery
An oesophagogastrectomy is a major operation. To make sure you’re well enough to have surgery, your doctor may do some of the following tests.
- Blood tests to check your general health.
- Tests to check your breathing (called lung function tests).
- An exercise test to see how fit you are. You may be asked to climb some flights of stairs, for example. Your fitness can affect your chances of getting complications after surgery.
- A cardiopulmonary exercise test. You may be asked to run on a treadmill or use a stationary bike to see how well your heart and lungs work.
- An electrocardiogram. This records the rhythm and electrical activity of your heart.
- An echocardiogram. This uses ultrasound to create moving images of your heart to see how well it’s working.
- A chest X-ray to check the health of your heart and lungs, and to make sure you don’t have an infection.
Preparing for an oesophagogastrectomy
Depending on what type of cancer you have, you may be given a course of chemotherapy or radiotherapy (or both) before your operation.
You’ll meet the surgeon who’s going to do your procedure to discuss your care. It may be different from we’ve described here as it will be designed to meet your individual needs.
Your surgeon will explain how to get ready for your procedure. If you smoke, you’ll be recommended to stop. This is because smoking increases your risk of complications such as getting an infection, which can slow down your recovery after surgery.
You may be given a laxative to help clear your digestive system before your operation.
You’ll have an oesophagogastrectomy under general anaesthesia. This means you’ll be asleep during the procedure. A general anaesthetic can make you sick so it’s important that you don’t eat or drink anything before surgery. Follow your anaesthetist’s or surgeon’s advice – it’s important to have an empty stomach before having a general anaesthetic.
You ‘ll need to wear compression stockings to keep your blood flowing and to stop blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine (or tablets) as well.
You may be given antibiotics just before your surgery to reduce the chances of an infection.
Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you‘re happy to give your consent for the operation to go ahead. You’ll be asked to do this by signing a consent form.
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How healthy are you?What happens during an oesophagogastrectomy?
How long your procedure takes can vary, depending on exactly which type of operation you have. Your surgeon will explain your procedure to you and whether they’ll use open or keyhole surgery.
- In open surgery, your surgeon will make two large cuts, one to the top of your tummy and another to your chest. They may need to get to the top part of your oesophagus during the operation too. If so, they’ll make a cut in your neck, but this doesn’t happen very often.
- In keyhole surgery, your surgeon will make several small cuts.
During the operation, your surgeon will take away the diseased part of your oesophagus and stomach. How much they take away will depend on many things, including the type of tumour (cancerous growth) you have and where it is. Your surgeon may then join the remaining part of your oesophagus to the healthy part of your stomach.
If they need to remove all of your stomach, your surgeon may attach your oesophagus to your small bowel. They’ll take away any nearby lymph nodes (small glands that are part of your immune system) to check for cancer cells that may have spread to them. This will help to find out if you need any more treatment after surgery.
Your surgeon may put a feeding tube called a jejunostomy into your small bowel. You’ll be able to have liquid food through this tube for a while after your operation until you recover.
What to expect afterwards
After your operation, you’ll be transferred to the intensive care or high dependency ward. You’ll usually stay there for a day or two before moving back to the surgical ward.
You may feel sore as the anaesthetic wears off. But you'll be offered pain relief when you need it.
When you wake up after the surgery, you’ll notice several tubes sticking out of you. These may include:
- a catheter to drain urine from your bladder into a bag
- tubes to drain blood and fluid from your wound while it heals
- a drip in a vein in your hand, arm or neck to give you fluids and blood transfusions if you need them
- a jejunostomy tube coming out of your stomach from your small bowel to give you nutrients while you recover
Your nurses will encourage you to get out of bed when you feel ready. Moving around soon after your operation may help to speed up your recovery. A physiotherapist will give you some exercises to help your breathing and posture.
You won’t be able to eat anything for several days while you heal. You’ll get the nutrition you need through the jejunostomy tube.
Sometimes, you may have a contrast X-ray about a week after your operation. This is where you swallow a special dye so that your surgeon can clearly see your organs on the X-ray image. They can then check whether or not the join between your oesophagus and stomach has healed.
You’ll usually be able to go home about 10 to 14 days after your operation. Make sure someone can take you home. And ask them to stay with you for a day or so while you get back on your feet.
Before you leave, your surgeon will discuss how the procedure went. They may be able to give you the results of tests on your tumour then. Or you may need to wait until your follow-up appointment to find out the results and whether or not you need any more treatment. Your nurse will give you some advice about caring for your healing wounds and may give you a date for a follow-up appointment.
Recovering from oesophagogastrectomy
Everyone recovers differently from an oesophagogastrectomy. How quickly it takes to recover varies from person to person too. So, it’s important to follow your surgeon’s advice. If you had a keyhole procedure, you may recover faster than if you had open surgery.
You may feel very tired after surgery and it can take a while to get your energy back. It’s important to go for a walk every day and do any exercises recommended by your physiotherapist. But try to rest after meals and to take an afternoon nap. You should also rest before and after exercise. For more information on this, see our FAQ: When can I exercise after an oesophagogastrectomy? below.
You may have some pain in your chest around your wound for several weeks or even months. If you need something to help with the pain, you can take over-the-counter painkillers such as paracetamol. Or your surgeon may prescribe some painkillers for you to take home. Always read the patient information that comes with your medicine. If you have any questions, ask your surgeon or pharmacist for advice.
You’ll need to make some changes to your diet after your operation. At first, you’ll only be able to eat small amounts of food in one sitting. Your dietitian or surgeon will explain how to start eating solid foods again. To begin with, you’ll need to eat only soft foods. You may need to take vitamin and mineral supplements to help you recover. For more information on this, see our FAQ: Will I need to change my diet after my operation? below.
If you have a jejunostomy tube, you can have this removed once you’re eating enough solid food. This is usually after about three to six weeks and is a minor day-case procedure.
It’s natural to feel emotional after having major surgery, especially if you’re very tired or can’t do your usual activities. If you’re feeling anxious or down, speak to your GP.
Side-effects of oesophagogastrectomy
Everyone responds differently to an oesophagogastrectomy, but afterwards you may:
- feel very tired
- have a poor appetite
- have some pain in your chest
- have diarrhoea for a few days
- have a dry cough – sometimes for up to a year
You’ll have a scar on your chest, tummy or on your neck. Your scar may be slightly raised and swollen at first, but this should gradually settle over time.
Complications of oesophagogastrectomy
Everyone is different, but sometimes oesophagogastrectomy can cause a few complications.
- Leaking from the join between your oesophagus and stomach is one of the most serious complications. If this happens, you’ll need to stay in hospital while it’s treated and won’t be able to eat or drink. If other treatments don’t work, you may need another operation to repair it.
- If your oesophagus is torn during the operation, you may get an infection called mediastinitis. This can cause very bad chest pains and fever. You may need antibiotics or an operation to repair the tear.
- The new join can be narrow at first. It may need gentle stretching to reopen it.
- Acid in your stomach can rise into your oesophagus, causing heartburn (acid reflux). This is because there’s no longer a valve (barrier) at the bottom of your oesophagus.
- Food may pass too quickly through your digestive system causing dumping syndrome. You may feel dizzy, hot, sick and faint, with pain in your tummy. Your surgeon can give you advice on how to cope with this.
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Will I need to change my diet after my operation?
You’ll need to take things slowly at first. The join between your oesophagus and stomach will be quite narrow after your surgery, so only fluids and soft food will fit through it. It may also be swollen and sore as it heals.
Start off with small sips of water and then gradually move on to thicker liquids such as milk and soup. After a couple of weeks, you should be able to eat some soft foods. Chew your food well so it’s easier to swallow and digest.
Your stomach will be smaller after the operation, so you’ll feel full much more quickly than before. It’s usually best to have small portions regularly throughout the day, rather than three big meals a day. These will be easier for your stomach to cope with.
You’ll usually see a dietitian after your surgery. They’ll give you advice on eating well. They may recommend you have some high-protein, high-calorie foods or supplements for a while to help you recover. You should be able to eat a normal diet again within a few weeks.
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When can I exercise after an oesophagogastrectomy?
Oesophagogastrectomy is a major operation. You’ll need to take it easy for a while and gradually increase how active you are. Your physiotherapist will show you some exercises to help your recovery and boost your strength.
To start with, try walking around your home. Build up slowly and walk a bit more each day until you’re ready to go outside. It’s important not to push yourself – if you feel tired, stop and rest for a while. Eventually, you’ll be able to keep active for at least 30 minutes every day, even if it’s just a few short walks.
After around three to six months, you should be able to do some other exercise such as swimming, cycling and dancing. It may take you longer to get back to more active exercises. And wait until you’re back to full fitness before you do anything more strenuous, such as lifting weights.
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When can I return to work?
How quickly you can go back to work will depend on many things, including your age and general health. It depends on how well you recover from surgery and on the type of work you do. It also depends on whether or not you need any more treatment after surgery. Most people can go back to work after two to four months. But make sure you get the go-ahead from your surgeon or doctor first.
When you do go back to work, build up over three or four weeks. You’ll probably find it really tiring to start with, so it’s important to take regular breaks. Start off with a couple of hours at a time and some light duties and see how you feel afterwards. If you’re struggling to cope with heavy work or long hours, speak to your employer. You may be able to work part-time for a few months or change your duties.
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Indigestion
Indigestion medicines can be used to relieve pain or discomfort in your upper abdomen (tummy) or chest that may occur soon after meals.
Healthy eating
Healthy eating is especially important if you have cancer. Take a look at our tips to help make sure you're eating as well as you can.
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Other helpful websites
- The Oesophageal Patients Association
www.opa.org.uk - Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk - Cancer Research UK
0808 800 4040
www.cancerresearchuk.org
- The Oesophageal Patients Association
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Author information
Reviewed by Victoria Goldman, Freelance Health Editor and Michelle Harrison, Specialist Health Editor, Bupa UK Health Content Team
Expert reviewer, Mr Stephen Pollard, Consultant Surgeon
Next review due December 2022
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