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Oesophagogastrectomy

An oesophagogastrectomy is an operation to remove the upper part of your stomach and the lower part of your oesophagus. Your oesophagus is the pipe that goes from your mouth to your stomach. You might need this operation if you have cancer at the junction between your stomach and oesophagus.

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.

Here we explain about what happens before surgery, what the operation involves, recovering afterwards, and some frequently asked questions.

An image showing removal of part of the oesophagus and stomach

Details

  • Tests before surgery Tests to see if you need surgery

    Before you have an oesophagogastrectomy, your specialist doctor will need to do some tests to make sure the procedure is right for you.

    • Endoscopy. In this procedure, your doctor will look inside your oesophagus, stomach and the first part of your small bowel (duodenum). They may also take a small sample of cells, called a biopsy, which will be tested for cancer.
    • CT or MRI scan. These are used to find out the size of a tumour and if the cancer has spread.
    • Chest X-ray, which also looks to see if the cancer has spread.
    • Barium swallow and meal. This test allows X-ray images of your tummy to show the inside of your oesophagus and stomach more clearly.
  • Fitness for surgery Checking you’re fit for surgery

    An oesophagogastrectomy is a major operation. To make sure you’re well enough to have it, your doctor will do some more tests. These may include those listed below.

    • 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. This might involve climbing a couple of flights of stairs, for example. Your fitness can affect your chances of getting complications after surgery.
    • A cardiopulmonary exercise test, which may involve running on a treadmill or using 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 produce 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.
  • Preparation 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. 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, it’s best to quit. Smoking can affect the success of your operation, and also increase your risk of getting a chest and wound infection, which can slow your recovery.

    You might need to take a laxative to help clear your digestive system before your operation. Your hospital will give you some advice about this.

    An oesophagogastrectomy is done under general anaesthesia. This means you’ll 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 before your oesophagogastrectomy. Follow your anaesthetist’s and surgeon’s advice and if you have any questions, just ask.

    Your surgeon will already have gone through everything in detail before you go to hospital for your oesophagogastrectomy. They’ll also have given you the opportunity to ask questions about the risks, benefits and alternatives to the operation. Once you get to hospital, they’ll go over what will happen before, during and after your operation, and any pain you might have. By this stage, you will have all the information you need to give your consent for the oesophagogastrectomy to go ahead. You’ll be asked to sign a consent form.

    You might need to wear compression stockings to help prevent blood clots forming in the veins in your legs. Your surgeon may also give you an injection of an anti-clotting medicine such as tinzaparin or dalteparin.

  • The procedure What happens during an oesophagogastrectomy?

    How long your procedure takes can vary – it depends on exactly which type of operation you have.

    Your surgeon can use either open or keyhole surgery.

    • In open surgery, your surgeon will make two large cuts into the top part of your tummy and chest. Sometimes they might need to get to the upper part of your oesophagus during the operation. If so, they’ll need to make a cut in your neck, but this isn’t common.
    • In keyhole surgery, your surgeon will make several small cuts instead.

    Your surgeon will explain your procedure and whether they’ll do open or keyhole surgery.

    During the operation, your surgeon will remove the diseased part of your oesophagus and stomach. The amount they remove will depend on things like the type of tumour you have, and where it is. They might then join the remaining part of your oesophagus to the healthy part of your stomach.

    Your surgeon might attach your oesophagus to your small bowel if they need to remove your whole stomach. They’ll also remove any nearby lymph nodes to check for cancer cells. This will help to find out if you need any additional treatment after surgery.

    Your surgeon may put a feeding tube called a jejunostomy into your small bowel, and bring this to the surface of your skin. You’ll be able to have food in the form of liquid through this tube for a while after your operation until you recover.

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  • Aftercare What to expect afterwards

    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 might also have the option of 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.

    When you wake up after the surgery, you’ll notice some tubes.

    • You may have a catheter (tube) to drain urine from your bladder into a bag.
    • You might have fine tubes running out from the wound. These will drain fluid into another bag while your wound heals.
    • You’ll have a drip in 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 a little water.
    • You’ll probably have a fine tube in one nostril, called a nasogastric tube. This will go across the area where your oesophagus and stomach have been joined.
    • You might have a tube coming out of your stomach from your small bowel. This is called a jejunostomy and will enable you to receive nutrients while you recover.
    • You might have an epidural to give you pain relief.

    Your nurses will encourage you to get out of bed when you feel ready. A physiotherapist might be on hand to help you. If you move around after your operation, it can help to prevent complications and may help to speed up your recovery. You’ll also have injections to help prevent blood clots.

    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.

    You’ll usually be able to go home about a week 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 come and see you to discuss how the procedure went and any further treatment you might need. Your nurse will give you some advice about caring for your healing wounds and may give you a date for a follow-up appointment.

  • Recovery Recovering from oesophagogastrectomy

    The 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, you might recover faster than if you had open surgery.

    If you need something to help with the pain, you can take over-the-counter painkillers such as paracetamol. Or your surgeon might prescribe some painkillers for you to take home. Always read the patient information that comes with your medicine and 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 hospital will give you some instructions about how to eat well while you recover. To begin with, you’ll need to eat only soft foods. Your dietitian or surgeon will explain how to start eating solid foods again. You might need to take vitamin and mineral supplements to help you recover. See our FAQ: Diet after surgery, for more information about what to eat after your operation.

    If you have a feeding tube, which is called a jejunostomy, you can have this removed once you’re eating enough. This is usually after about two to three months.

  • Side-effects Side-effects of oesophagogastrectomy

    As with every procedure, there are some risks associated with oesophagogastrectomy. We haven’t included the chance of these happening as they 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. You might have some pain afterwards. You may also have diarrhoea for the first few weeks, and a dry cough for a while – sometimes up to a year.

    Depending on where your surgeon made the cuts, you will have a scar on your chest, abdomen (tummy) or rarely, on your neck. Although your scar may be slightly raised and swollen at first, this should gradually settle over time.

  • Complications Complications of oesophagogastrectomy

    Complications are when problems occur during or after the procedure. Complications of oesophagogastrectomy can include the following.

    • The join between your oesophagus and stomach leaking. This is one of the most serious complications, and you may need another operation to repair it.
    • An infection called mediastinitis, which can cause severe chest pains and fever. This can happen if your oesophagus is torn during the operation. Mediastinitis can be treated with antibiotics or you can have an operation to repair the tear.
    • 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. So this means you won’t have a barrier to stop the acidic contents of your stomach pushing up into your oesophagus.

    When this happens, it causes heartburn. See our topic on indigestion for some self-help tips on how to prevent heartburn: the advice is the same in both cases.

  • FAQ: Diet after surgery Will I need to change my diet after my operation?

    Yes, you’ll need to take things slowly at first. You’ll have some swelling after the operation and to begin with, the join between your oesophagus and stomach will be quite narrow. This means that only fluids and soft food will go through it.

    You can start with small sips of water and then gradually have things like fruit squash, tea and coffee, milk and soup. You can then progress to eating soft foods for two or three weeks after your procedure. This will help the new join between your stomach and oesophagus to heal. You might need to follow a diet that’s high in protein and take vitamin supplements to help your recovery too.

    It can take a few weeks or even months for your stomach to recover before you can eat a normal diet. Your stomach will be smaller after the operation so you’ll feel full much quicker 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 manage.

    You’ll usually see a dietitian after your procedure who will give you some more advice about how to eat well while you recover.

  • FAQ: Exercise after surgery When can I exercise after an oesophagogastrectomy?

    Oesophagogastrectomy is a major operation and you’ll need to take it easy for a while. Take things slowly for the first few weeks and then gradually build up the amount of physical activity you do.

    Immediately after your procedure, you’ll need to rest in bed. On the second day, try to get up and sit in a chair (unless you have an epidural). Over the next few days, your physiotherapist will show you some exercises to do that will help your recovery and improve your strength.

    Once you get home, 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. Build up your activities gradually and do a bit more each day. There aren’t any types of exercise that you won’t be able to do eventually. But wait until you’re back to full fitness before you do any strenuous activities, such as lifting weights.

  • FAQ: Going back to work When can I return to work?

    Will I need to change my diet after I’ve had an oesophagogastrectomy?

    Answer

    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.

    Explanation

    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?

    Answer

    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.

    Explanation

    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.

    The exact amount of time you’ll need to have off work will be specific to you. This is because it not only depends on how well you recover from the procedure, but also on the type of work you do. Other things to consider include your age, general health, and whether you’re having any more treatment, such as chemotherapy or radiotherapy.

    It’s likely that you’ll need to be off work for about two to four months, although it might be longer. Make sure you get the go-ahead from your surgeon or doctor before you go back. When you do go back to work, you’ll probably find it really tiring to begin with, so it’s important to take regular breaks. It’s a good idea to ask your employer if you can go back part-time at first. Keep them up-to-date about your treatment, as you may need to arrange some time off for further treatments or check-ups.

  • Resources Resources

    Further information

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    • Oesophageal cancer. British Society of Gastroenterology. www.bsg.org.uk, accessed 12 April 2017
    • Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut 2011; 60:1449–72. doi:10.1136/gut.2010.228254
    • Esophagogastroduodenoscopy. Medscape. emedicine.medscape.com, updated 22 February 2017
    • Oesophageal cancer. PatientPlus. patient.info/patientplus, last checked 24 November 2014
    • Upper gastrointestinal surgery. OSH operative surgery (online). Oxford Medicine Online. oxfordmedicine.com, published October 2011
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    • Pre-operative chest radiographs (CXR) for elective surgery. Royal College of Radiologists. www.rcr.ac.uk, last reviewed 20 October 2016
    • Map of medicine. Upper gastrointestinal (GI) cancer. International view. London: Map of medicine; 2015 (Issue 4)
    • Get well soon: helping you to make a speedy recovery after surgery to remove a cancer of the gullet or upper stomach. Royal College of Surgeons. www.rcseng.ac.uk, accessed 12 April 2017
    • Personal communication, Mr Stephen Pollard, Consultant Surgeon, 26 April 2017
    • Venous thromboembolism: reducing the risk for patients in hospital. National Institute for Health and Care Excellence (NICE), 27 January 2010. www.nice.org.uk
    • Low molecular weight heparins. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed April 2017
    • Map of medicine. Barrett’s oesophagus. International view. London: Map of medicine; 2015 (Issue 1)
    • A guide to life after oesophageal/gastric surgery – oesophagectomy and gastrectomy. The Oesophageal Patients Association. www.opa.org.uk, revised September 2013
    • Yuan Y, Zeng X, Hu Y, et al. Omentoplasty for oesophagogastrostomy after oesophagectomy. Cochrane Database of Systematic Reviews 2014, Issue 10. doi:10.1002/14651858.CD008446.pub3
    • Surgery for cancer of the esophagus. American Cancer Society. www.cancer.org, last revised 4 February 2016
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    • Lifestyle changes after cancer of the esophagus. American Cancer Society. www.cancer.org, last revised 4 February 2016
    • After surgery. Cancer Research UK. www.cancerresearchuk.org, last reviewed 5 July 2016
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, May 2017
    Expert reviewer, Mr Stephen Pollard, Consultant Surgeon
    Next review due May 2020

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