Undergoing Surgery for Esophageal Cancer: “10 Important Things You Need to Know”

Esophagectomy is a complex procedure, but it can be performed with a high degree of safety, especially in the era of minimally invasive surgery.

Dr. Archit Pandit specializes in esophageal cancer surgery and has completed fellowships at some of the world’s leading centres in Japan and South Korea, with a special focus on esophageal cancer surgery.

Dr. Archit Pandit believes that successful esophageal cancer surgery requires a thorough discussion with the dietitian, physiotherapist, surgeon, and family members to understand the complexities of the procedure and the lifestyle changes required after surgery.

Type of Surgery

Laparoscopic / Robotic / Open Surgery

Dr. Archit Pandit is an expert in performing laparoscopic and robotic cancer surgeries. You can click on the link to understand how this surgery is performed.

The advantages of laparoscopic and robotic esophagectomy include:

• Less blood loss
• Faster recovery
• Shorter ICU stay
• Lower mortality
• Reduced risk of complications

You can also visit the link to watch a video explaining the benefits of minimally invasive esophageal surgery over open surgery.

This technique is particularly beneficial for elderly patients who are often considered high-risk for conventional surgery. One of our 84-year-old patients successfully underwent this procedure. Click on the link to hear about his experience.

Before Surgery

Most patients undergo chemotherapy or chemoradiation before planning surgery.

The interval between completing treatment and surgery is called the Golden Period.

During this period, it is extremely important to focus on the following:

• High-calorie and high-protein diet
• Chest physiotherapy or incentive spirometry to improve lung capacity, which is essential for a successful surgery and reducing postoperative complications
• Regular physical exercise or yoga

More information about the Golden Period is available in the link provided.

During Your Hospital Stay

While in the hospital, the patient is generally admitted to the ICU for at least one day and is usually shifted to the room on the second or third postoperative day.

A nasojejunal (NJ) three-lumen tube is inserted through the nose. This tube helps in:

• Draining gastric secretions
• Providing nutrition during the initial postoperative period until oral feeding is started

In some cases, a feeding jejunostomy tube may be placed through the abdomen to provide nutritional support.

These feeding tubes are generally required for the first 5–6 days after surgery to prevent nutritional depletion, after which oral feeding is gradually started.

After Surgery

Once the surgery has been performed, the following precautions should be followed.

1. Maintain a 30° Upright Position

After esophageal cancer surgery, food may tend to regurgitate into the chest, causing cough or acid reflux.

To minimise this, patients are advised to keep the head elevated by using two pillows behind the back, maintaining approximately a 30-degree upright position.

2. Eat Small, Frequent Meals

The stomach becomes smaller after esophagectomy.

Therefore, it is advisable to eat small meals 6–7 times a day instead of a few large meals. Patients can usually continue eating their normal foods but in smaller quantities to meet their nutritional requirements.

3. Avoid Lying Down Immediately After Meals

Maintain a gap of 1–2 hours between eating and sleeping.

This allows food to move from the stomach into the small intestine and helps reduce the risk of regurgitation.

4. Chew Your Food Thoroughly

Chewing food well helps ensure smooth passage through the newly constructed food pipe and the surgical connection (anastomosis).

5. Eat a Balanced Diet

Most patients can gradually return to eating the foods they enjoy.

However, some patients may experience:

• Sweating
• Palpitations
• Bloating
• Diarrhoea

This condition is known as Dumping Syndrome and is generally not a cause for concern.

Reducing the intake of high-carbohydrate and sugary foods usually helps improve these symptoms.