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What is Oesophageal Cancer?

Oesophageal cancer, is a disease that originates in the lining of the oesophagus. While it is more prevalent among individuals over the age of 60, oesophageal cancer can affect people of all ages. Risk factors for this type of cancer include gastroesophageal reflux disease (GORD), obesity, smoking, excessive alcohol consumption, and certain dietary habits.

Diagnosis and Staging:

Accurate diagnosis and staging are crucial for effective treatment of oesophageal cancer. Diagnostic procedures may involve endoscopy, imaging tests such as CT scans or PET scans, and biopsy to obtain tissue samples for analysis. Staging procedures, including endoscopic ultrasound and laparoscopy, help determine the extent of cancer spread to nearby lymph nodes or other organs.

Multidisciplinary Management:

The management of oesophageal cancer often necessitates a multidisciplinary approach, involving a team of healthcare professionals with specialised expertise. Alongside your surgeon, your care team may include medical oncologists, radiation oncologists, gastroenterologists, pathologists, and other specialists. This collaborative approach ensures comprehensive evaluation, personalised treatment planning, and continuous monitoring to optimise your outcomes.

Minimally Invasive Approaches:

The specific surgical approach for oesophageal cancer depends on the location and stage of the tumor. In recent years, significant advancements in surgical techniques have paved the way for minimally invasive procedures in the treatment of oesophageal cancer. These minimally invasive techniques utilise smaller incisions, resulting in reduced postoperative pain, minimal scarring, shorter hospital stays, and quicker recovery times for patients.

Post-operative Care

After a short time in the recovery ward, you will be back in your room, possibly still with an IV drip attached.

You will be offered sips of water initially to ensure you don’t become nauseated, and once you are tolerating liquids well you will be offered a light diet. If nausea is a problem, you will be given medication.

You will have some elastic compression stockings on and should continue to wear these for 2 or 3 days post-op until you are fully mobile. These lessen the risk of developing blood clots.

You should get up to the toilet as soon as you are able, as moving around lessens complications such as blood clots and chest infections. You will be encouraged to do deep breathing exercises (smoking is discouraged).

  • You will be given pain relief medication. This is most effective taken regularly, rather than waiting until pain builds up. Sometimes a combination of pain medication is advised.
  • Please ensure all doses and medications are explained to you before you leave the hospital.
  • If you have what you consider to be excessive pain, despite taking pain relief, contact our Rooms, or your surgeon

  • The small incisions have waterproof dressings on them that can be left on for 5 days but may be removed and left exposed before if they begin to lift off.
    Do not soak in a bath or spa until the wound is fully healed.
  • If you have stitches, this will be discussed with you (normally the stitches are dissolving).
  • It is common to experience some tenderness, swelling or bruising around these sites.

Eating and drinking

Initially after the operation you will not have anything to eat or drink until your surgeon is happy the join in your oesophagus is healing well. At this time, you will be allowed to start drinking fluids and then progress to including soft foods as well. The dietitian will work with you and your surgical team to progress your diet and optimize nutrition to aid your recovery.

It may take some time for your appetite to return to normal. Since part of your stomach will be removed, you will not have the same capacity for food you previously had. While reintroducing food, it will be important to eat “little and often” throughout the day. This will prevent discomfort while still making sure you get enough nutrition in. A dietitian will help guide you on what to eat throughout this time and will give you detailed advice about food to eat when you get home.

Feeding tube

In some cases, your surgeon may decide to place a soft feeding tube through your abdominal wall into the gut below the operation site. Through this tube, you will receive liquid nutrition which will provide all the energy and protein you need until you are able to eat and drink enough on your own. If you do you go home with a feeding tube in place, the ward nurses will teach you how to care for the tube and you will be trained how to use it. Once at home, a district nurse and community dietitian will be in close contact to make sure you are managing well. Once you are eating enough, the tube can easily be removed in an outpatient clinic. Your surgeon can let you know before the operation whether they think they are likely to place a feeding tube or not.

The physiotherapist and nurse will aim to get you up into a chair from the day after your operation. You will then be assisted to walk a short distance with your level of activity increasing as you recover. Walking regularly is important for your recovery.

There are some potential longer term consequences of Ivor Lewis operation. You may, or may not, experience any of these.

Oesophageal stricture

Scar tissue contracts as it heals. Too much contraction can cause a narrowing, or stricture, at the point of the anastomosis. If this happens, you will begin to experience the same difficulty in swallowing that you had before your operation. This can be alarming as you may be worried that the cancer has come back. It is important that you let your surgeon know because a stricture can be successfully treated.

Oesophageal reflux

After an Ivor Lewis operation, the ring of muscle between the oesophagus and stomach, which prevents reflux, is lost. This means that stomach acid can reflux and cause heartburn. This can be helped by changing eating habits and medication. Many patients need to sleep more upright after an Ivor Lewis operation.

Dumping syndrome

Dumping syndrome is a rare consequence of the Ivor Lewis operation. It occurs when food, especially sugar, moves from the remaining stomach into the small bowel too quickly. The body then releases large amounts of insulin which causes blood sugar levels to drop. This results in nausea, abdominal cramps, sweating, diarrhoea, and dizziness or light-headedness. Dumping symptoms can occur within a short time of eating, or one to three hours from eating.

Symptoms can be improved by eating small amounts at regular intervals, reducing the sugar in your diet, eating slowly and avoiding drinks or liquids close to mealtimes. Should you experience symptoms of dumping, the dietitian will give you advice on how to manage this.

Diarrhoea

The vagus nerves that supply the bowel and help coordinate bowel movements are disrupted during the operation which can result in diarrhoea. This can usually be controlled with medication and improves over time.

Alteration in diet:

It may take some time to adjust to new eating patterns. Your stomach will be smaller after the operation, so you will be advised to eat smaller meals and have snacks between meals. Avoiding large meals will prevent feeling bloated or getting too full, and having extra snacks will make sure you are getting enough nutrition in.

Loss of weight

It is common to lose weight in the recovery phase after surgery, with some people losing between 5-10% of their initial body weight. After a few weeks, weight usually stabilizes. While everyone is different, most people will maintain their weight or gain some weight back in the months following surgery. The dietitian can give you advice if you are concerned about weight loss and may recommend high calorie foods or nutritional supplements.

Please make a follow-up appointment with your surgeon in about 7-14 days, once you are home from hospital.

If you need urgent medical attention, please present to North Shore Hospital Emergency department.

Why choose us?

Highly trained

Dr Jason Robertson is a New Zealand and Internationally highly trained surgeon, ensuring your surgery is performed safely and effectively, minimising the risk of complications.

Team approach

Every surgery involves a multidisciplinary team to provide comprehensive care that addresses all aspects of the patient’s health and well-being.

Comprehensive care

A specialist trained team will provide follow-up care ensuring the treatment outcome is sustained and any complications are addressed.