When it is recommended
This is among the most complex operations in abdominal surgery, and outcomes are best in the hands of high-volume surgeons working in experienced centres. The main indication is oesophageal cancer, sometimes preceded by chemoradiation to shrink the tumour.
Other indications are severe Barrett’s oesophagus with high-grade dysplasia that cannot be controlled endoscopically, and advanced end-stage motility disorders.
How the operation is performed
Most commonly a combined laparoscopic and thoracoscopic approach (minimally invasive Ivor-Lewis or McKeown oesophagectomy), though open surgery is chosen in selected cases.
The diseased oesophagus is removed along with nearby lymph nodes; the stomach is reshaped into a tube and pulled up into the chest (or neck) to replace the oesophagus.
Recovery
Hospital stay is typically 10–14 days, with the first 48–72 hours in a high-dependency or intensive-care setting. Liquids for the first week via a feeding tube in some cases; gradual advance to soft then regular diet over 4–6 weeks. Full recovery takes 3–6 months.
Long-term adjustments
Because the new food-pipe is less muscular than the oesophagus it replaces, patients eat small, frequent meals, chew thoroughly, avoid drinking large volumes with meals, and sit up or walk for 30–60 minutes after eating rather than lying flat.
Anti-reflux precautions (an elevated head of bed, no late-night eating) are lifelong. Most patients return to a good quality of life.