This page provides information about the investigation of and surgery to treat cancer of the oesophagus. It aims to answer some of your questions about the operation and its risks and benefits. Please ask if there is any information you need or if you have any further questions.
The oesophagus is a tube that transports food and drink from the mouth to the stomach. The oesophagus sits in the chest.
Cancer of the oesophagus is a cancer that grows in the oesophagus and will often cause difficulty swallowing which can lead to weight loss. It may also cause vomiting or anaemia (low levels of red blood cells). Oesophageal cancer is one of the ten most common cancers in the UK. Removing the cancer with surgery may cure it.
To diagnose this cancer we use a thin flexible camera inserted through the mouth (called an endoscope) to look at the oesophagus directly. We will also arrange a CT scan.
Some patients will have additional tests such as a PET scan, an endoscopic ultrasound (a procedure using an endoscope with an ultrasound probe at the end) or a laparoscopy (keyhole surgery) which is done under general anaesthetic.
After these tests have been done we will advise you of the need for an operation to remove the cancer. The purpose of the operation is to remove the cancer with the surrounding tissue. This involves removing part, or all, of the oesophagus and is called an oesophagectomy. The stomach is then connected to the part of the oesophagus that remains in the chest or neck. The new join which is made is called an anastomosis.
Before oesophagectomy
After oesophagectomy
If surgery is required we will explain the details of the operation and recommend that you have a course of chemotherapy before surgery. The course of chemotherapy usually lasts for about nine weeks. The purpose of the chemotherapy is to shrink the main cancer in your oesophagus and to treat any cancer cells that may have started to spread to other areas of the body. After the chemotherapy we will arrange a repeat CT scan to assess how well the body has responded to the chemotherapy. You will then have surgery around six to eight weeks after the chemotherapy has ended.
An oesophagectomy is a big operation. The most common complications are:
- Problems which affect the lungs – these can include complications such as chest infection, fluid around the lungs and collapsed lungs. It is very important that you breathe deeply after the operation and that you work closely with physiotherapy staff who will see you on the ward.
- Wound infections – a wound infection can usually be treated with simple wound care or antibiotics. Sometimes removing the clips we use to close your wound may help.
- Bleeding – you may need a blood transfusion if you lose a lot of blood.
- A leak from the new join – this happens in about ten percent (one in every ten) of patients and in most cases the leak will heal by itself. You will not be able to eat or drink while it heals. Rarely, you may need another operation to deal with this problem. You may also need to stay in hospital for several weeks longer than planned.
- Weight loss – you may need to take supplements to help meet your nutritional needs while you adjust to changes from the operation. We usually place a feeding tube directly into the small bowel, through the wall of your abdomen, during the surgery. This is called a jejunostomy and stays in place until you can maintain your nutrition after the surgery. If you need further chemotherapy after your surgery we may leave the tube in place until this has finished.
- Chyle leak – this is a leak of creamy fluid and most often stops on its own. Occasionally we may need to perform another operation to seal the leak.
- Death – we usually quote a one per cent (one in every hundred patients) risk that you will not survive the surgery.
If your surgical risk is higher than normal then your surgeon will discuss this with you.
There are also risks associated with having a general anaesthetic. You will see an anaesthetist on the day of your operation who will discuss the risks with you.
The only treatment that provides a cure for most oesophageal cancers is surgery combined with chemotherapy. However, there are other treatments that can help and may improve symptoms. These include radiotherapy, chemotherapy, laser therapy and stent insertion (a stent is used to keep the oesophagus open).
Each person’s cancer is different and therefore there is no single treatment that is suitable for everyone.
We need you to be in the best condition possible to help you get through the surgery. This includes good nutrition, which we can help you with. If you smoke you must stop smoking at least one month before your treatment starts.
You will be seen in the pre-assessment clinic a few weeks before your operation to discuss the anaesthetic and make sure you are fit for surgery. We will give you information about fasting before the operation and how to take your medications.
By law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign the form. If you are unsure about any aspect of the procedure, please speak with a senior member of staff again.
Before the operation starts the anaesthetist will spend time placing an epidural (anaesthetic placed next to the spine) as well as starting the general anaesthetic. You will also have other tubes connected to you to drain urine, empty the stomach and at the end of the operation you will also have drains to empty the chest of any excess fluid and help re-expand the lungs. You will also have a feeding tube after the operation. This will either go directly into the small bowel through the abdominal wall (jejunostomy) or into a vein in the neck.
There are different ways of performing an oesophagectomy. Most patients will have a cut in the upper part of the abdomen as well as one in the chest (either the left side or the right side). The cut in the abdomen may be replaced by small cuts. Sometimes we may also make a cut on the left side of the neck. We will discuss how your operation will be done before your surgery.
Your surgery will be performed by a team of surgeons led by a consultant. This is most often the consultant you met in outpatient clinic but sometimes will be another consultant from the same team.
After the operation you will be taken to the Critical Care Unit. We plan to keep you for a short while until it is safe to move you to the surgical ward.
We will try to control your wound pain as well as we can so that you are able to take deep breaths and cough comfortably. This is very important to help reduce the risk of a chest infection and you must tell the staff looking after you if you are in pain which means you cannot do this.
You will see physiotherapy staff early in your recovery to help you use your breathing and coughing muscles. We aim to get you out of bed as quickly as possible and keep you mobile to reduce the risk of infection and the risk of a blood clot forming. The tubes attached to you will be reviewed each day and removed when they are no longer needed. The tubes draining fluid from around the lungs can be uncomfortable but do help you breathe. They will usually stay in place for about five days.
You will be allowed to drink sips of water as soon as you are awake. We will tell you when it is safe to start eating and drinking. This can often take a week. Sometimes we may arrange a scan before you start eating or drinking.
The clips used to hold your wounds closed will be removed after about ten to fourteen days.
On average patients stay in hospital for about ten to fourteen days but you may stay in longer if you have a complication. Most patients go home using their own transport and may need to wait in the discharge lounge to be collected. We do not usually expect you to have problems at home but we will let you know if there are specific problems you need to look out for.
You will see a dietician who will help you to gradually move back to eating normal foods.
After the operation you will get your nutrition through a bag which is connected to your small bowel or a vein in your neck. If your recovery goes smoothly we expect you to start eating food around five to seven days after your operation. You will start on smooth fluids and work up to more solid foods.
You will need to change your eating habits, having much smaller meals around six times per day. This is because a large amount of food is likely to make you feel sick. You may also need to take supplements to help meet your nutritional needs.
There is a separate page which provides information about eating and drinking after oesophagectomy. Please ask for a copy if you do not have one.
It is normal to feel very tired for a few months after the operation. Many patients find the tiredness very frustrating so try to be patient with your recovery. Returning to work may take a couple of months and you will find that your energy levels improve gradually over the months after the operation.
We will arrange to see you in clinic around two weeks after you go home. At this time we will discuss how the operation has gone and whether you will need further treatment. After that we normally see patients every three months for the first year and then every six to twelve months for the next four years. We do not routinely arrange any tests.
If you have any concerns after you have gone home please contact your GP or contact us using the contact information below.
UCLH cannot accept responsibility for information provided by other organisations.
Clinical Nurse Specialist (Monday to Friday 09:00-17:00)
Direct line: 020 3447 5023
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 75023
E-mail: nathalie.
Pathway Co-ordinator (Monday to Friday 09:00-17:00)
Direct line: 020 3447 9202
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 79202
E-mail: uclh.
Upper Gastrointestinal Dietitian (Monday to Friday 09:00-17:00)
Direct line: 020 3447 9372
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 79372
Address: Upper Gastrointestinal Surgery Department, Ground Floor West, 250 Euston Road, London, NW1 2PG
Page last updated: 09 April 2025
Review due: 01 April 2027