What Is an Oesophagectomy and Why Is It Performed?

Facing a diagnosis that may require oesophageal surgery brings natural concerns about what lies ahead. The following information covers when oesophagectomy might be recommended, the different surgical approaches available, and what patients typically experience during treatment.

Oesophageal surgery is one of the most complex procedures in gastrointestinal surgery, requiring advanced training and experience. Dr Alex Craven is an upper gastrointestinal surgeon in Melbourne who focuses on complex oesophageal procedures.

Every patient’s situation differs. The decision for oesophagectomy requires careful evaluation of individual circumstances, overall health, and the specific condition present.

What is an Oesophagectomy?

An oesophagectomy is a surgical procedure that involves removing part or all of the oesophagus, the muscular tube that carries food from your mouth to your stomach. This operation is typically performed to treat serious conditions affecting the oesophagus, most commonly cancer.

The oesophagus plays a crucial role in your digestive system. After removal, the digestive pathway is reconstructed using part of the stomach, which is reshaped into a tube-like structure, or occasionally using part of the small intestine.

Oesophagectomy is considered when other treatment options are insufficient or when the condition poses significant health risks. An assessment of your overall health, the extent of your condition, and other relevant factors are conducted before this procedure is recommended.

What Are the Different Types of Oesophagectomy?

Several types of oesophagectomy procedures exist, each suited to different conditions and patient circumstances.

1. Partial oesophagectomy involves removing only the affected portion of the oesophagus. This approach is often used when the disease is localised to a specific area, allowing preservation of healthy oesophageal tissue.
   
2. Total oesophagectomy requires the complete removal of the oesophagus. This more extensive procedure is typically necessary when the condition affects multiple areas.
   
3. Subtotal oesophagectomy removes most of the oesophagus whilst preserving small portions at either end. This approach aims to balance thorough treatment with preservation of function where possible.

The choice of oesophagectomy procedure depends on the location and extent of the condition, the patient’s overall health, and treatment planning considerations.

What Are the Most Common Oesophagectomy Procedures?

1. Transthoracic oesophagectomy involves accessing the oesophagus through incisions in both the chest and abdomen. This approach, often called the Ivor Lewis procedure, provides excellent visualisation and is commonly used for tumours in the middle or lower oesophagus.
2. Transhiatal oesophagectomy accesses the oesophagus through incisions in the neck and abdomen, avoiding the need to open the chest. This approach may be suitable for certain conditions and can potentially reduce some surgical risks. Minimally invasive oesophagectomy—performed using keyhole techniques—may offer reduced pain, shorter hospital stays, and faster recovery compared to open surgery.
3. Three-stage oesophagectomy (McKeown procedure) involves incisions in the neck, chest, and abdomen. This comprehensive approach allows for complete removal and reconstruction, but it requires more extensive surgery. The reconstruction during oesophageal cancer surgery typically involves creating a new food pathway using the stomach, which is reshaped, or occasionally using part of the small intestine.

When Do You Need an Oesophagectomy?

Oesophagectomy is typically considered for serious conditions where other treatments have been insufficient or inappropriate.

• Oesophageal cancer – both adenocarcinoma and squamous cell carcinoma may require surgical removal as part of treatment.
• Severe GORD complications – when other treatments have failed and long-term reflux has caused significant damage, strictures, or pre-cancerous changes.
• Barrett’s oesophagus with high-grade dysplasia – pre-cancerous changes requiring intervention when other treatments are unsuitable.
• Severe oesophageal strictures that cannot be managed with other approaches to restore swallowing function.
• Urgent symptoms – severe difficulty swallowing, persistent chest pain, unexplained weight loss, or vomiting blood require immediate assessment.

What Should You Expect During an Oesophagectomy Consultation?

Your consultation will include assessment and discussion of your condition and treatment options. Dr Craven works with multidisciplinary teams, collaborating with oncologists and other specialists as needed for your care.

Before Your Visit

• Gather information about your symptoms – when they started and how they’ve changed
• Bring details of previous treatments and medications
• Note what makes your symptoms better or worse

During Your Consultation

• Discussion of your medical history and current symptoms
• Physical examination
• Review of imaging studies or endoscopy results
• Explanation of your diagnosis
• Discussion of treatment options
• Treatment planning based on your specific circumstances

Commonly asked questions

• What type and extent is my condition?
• Is surgery recommended, or do other options exist?
• Which surgical approach might be suitable?
• What does recovery involve?
• What ongoing care will I need?

Dr Craven collaborates with your GP and other healthcare providers throughout your care.

What Are the Risks and Benefits of Oesophagectomy?

Oesophagectomy carries significant risks and benefits that require careful consideration.

Potential Benefits

• Treatment of serious oesophageal conditions
• Relief from symptoms such as difficulty swallowing
• Prevention of complications from untreated conditions
• Improved quality of life in successful cases

Specific Risks

• Anastomotic leak – surgical connections are healing improperly
• Respiratory complications – due to chest surgery
• Eating pattern changes – significant changes in digestion
• Additional procedures may be needed
• Other organ complications – rare but serious

Long-term Considerations

• Permanent eating changes – smaller, more frequent meals are necessary
• Nutritional challenges – requiring ongoing monitoring
• Reflux symptoms – different types may occur

If you’re experiencing persistent swallowing difficulties, ongoing reflux symptoms, or have received a diagnosis requiring an assessment, book your consultation with Dr Craven to discuss your condition and explore treatment options.

Frequently Asked Questions

How long does oesophagectomy surgery take?

Oesophagectomy surgery typically takes 4-8 hours, depending on the complexity of the oesophagectomy procedure and the specific surgical approach chosen. The duration varies based on factors such as the extent of surgery required and any additional reconstructive work needed.

What will eating be like after oesophagectomy?

Eating patterns change significantly after oesophagectomy. You’ll need to eat smaller, more frequent meals and may require nutritional supplements to maintain proper nutrition. The stomach’s new shape and position affect how much you can eat at once. Dr Craven’s patient-centred approach includes dietary guidance and follow-up with the surgical team, including support from dietitians as needed.

Can oesophageal cancer return after surgery?

While oesophageal cancer surgery aims to remove all cancerous tissue completely, regular follow-up monitoring is essential as cancer can sometimes recur in the same area or develop elsewhere. Your surgical team will establish a detailed follow-up schedule to monitor your recovery and watch for any signs of recurrence.

What’s the difference between open and minimally invasive oesophagectomy?

Open surgery involves larger incisions to directly access the oesophagus, whilst minimally invasive techniques use several smaller incisions with specialised instruments and cameras. Minimally invasive approaches may offer reduced pain, shorter hospital stays, and faster recovery, but they’re not suitable for all patients or conditions. Dr Craven will discuss which approach best suits your specific condition based on his fellowship training and extensive experience.

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Medical Disclaimer: This information is general and does not constitute individual medical advice. Treatment outcomes vary between individuals, and results cannot be guaranteed. Oesophagectomy carries significant risks and benefits that should be discussed with qualified healthcare professionals. Always consult your doctor for advice specific to your situation. Seek immediate medical attention if you experience severe difficulty swallowing, persistent chest pain, unexplained weight loss, or vomiting blood.