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Oesophagectomy

The oesophagus (gullet) is the hollow muscular tube that carries food from the mouth down into the stomach. Oesophageal cancer is a malignant cancer that affects the tissues lining the oesophagus. It can occur in any part of the oesophagus. Treatment for oesophageal cancer aims at destroying these cancerous cells. Surgery is the most common treatment for oesophageal cancer.

Oesophageal cancer surgery aims at curing cancer by surgically removing the whole (total esophagectomy) or part of the oesophagus (esophagectomy) and the surrounding tissue that is affected. The left-out oesophagus is then reattached to the stomach after pulling it into the chest. When whole of oesophagus is removed the whole stomach is pulled up in the chest and is used to replace oesophagus. Sometimes a portion of the large intestine is cut and surgically attached to replace the oesophagus. To reduce the risk of recurrence of cancer lymph nodes from the surrounding area are also removed (lymphadenectomy). In case the cancer spreads to the stomach, upper part of the stomach is removed along with part of affected oesophagus (esophago-gastrectomy).

Surgery for oesophageal cancer can be done by either an open approach or by a minimally invasive approach using laparoscopy (minimally invasive esophagectomy). But in certain cases it sometimes becomes necessary to switch from minimally invasive to open approach depending on the situation. The type of the approach depends on the situation and is decided by the surgeon.

In an open approach a large incision is made on the neck, chest or tummy depending on the location of the cancer and the required procedure is done. In laparoscopic approach the surgery is done in two parts. First the portion of the affected oesophagus is removed laparoscopically through 3-4 small incisions in the chest. The surgeon can view the image on the monitor provided by the camera on the laparoscope inserted through one small hole in the chest during the surgery. The stomach is then reattached to the oesophagus either through a large incision or by laparoscopy. Laparoscopic approach is less invasive and thus leads to less pain and fewer complications.

The major complications of the surgery may include pneumonia and leaking of digestive fluids at the place where the stomach is attached to the remaining oesophagus. Surgery in severe cases of oesophageal cancer is mostly done after chemotherapy and radiation therapy.