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

Esophagectomy is a complex procedure but it can be performed with utmost safety especially during this era of Minimally invasive surgery. Dr. Archit Pandit specializes in Esophageal cancer surgery. He has undergone fellowship from the best of centers in the world like Japan and South Korea especially in the field of Esophageal Cancer Surgery. Dr. Archit Pandit suggests that esophageal surgery requires a thorough discussion with Dietician, Physiotherapist, Surgeon and Family member to understand the complexities involved and the life style changes one needs to adopt.

Type of Surgery

1. LAPAROSCOPIC / ROBOTIC / OPEN : Dr. Archit Pandit is an expert at performing Laparoscopic and Robotic Cancer Surgeries. One can click on the link to view how this surgery is performed. The advantages of performing Laparoscopic / robotic Esophagectomy are immense such as lesser blood loss, faster recovery, lesser ICU stay, less mortality and less chances of complications. One can visit this link to see the video on benefits of Minimally invasive Esophageal Surgery over Open surgery. This technique is very beneficial especially in elderly patients who are refused surgery due to their age and condition. One of our 84-year-old patient had undergone this surgery one can click on the link to see what he had to say.  

Before Surgery : Generally, you must have undergone Chemotherapy or Chemoradiation before planning for surgery. Gap between this and surgery is called the GOLDEN PERIOD. During this period, it is of utmost importance that you undergo the following three things

• High caloric and high protein diet.
• Chest physiotherapy or incentive spirometry for lung capacity which is very important for success of surgery and reducing complications
• Physical exercise / yoga. More about GOLDEN PERIOD is provided in the link ………….

During Hospital Stay :

• While in Hospital : While in the hospital the patient will be admitted in the ICU for at least 1 day and be shifted to the room on 2^nd or the 3^rd post-operative day. There will be a Naso-Jejunal 3 lumen tube inserted through the nose which will help in Gastric juice drainage and also help in purpose of initial few days of feeding till the time patients starts eating by mouth. Sometimes Feeding jejunostomy is a tube inserted in the abdomen which may be helpful for feeding purpose. The tube is usually required for the initial 5 to 6 days tom prevent nutritional depletion as after that oral diet is generally started.

After Surgery : Once the surgery is performed the following precautions need to be followed.

• 30° Upright position – After surgery for cancer of esophagus the food has the tendency to regurgitate back into the chest which may cause cough and acid reflux however to avoid this patient is advised to apply 2 pillows behind the back in order to elevate the head end of the patient. 
• Small quantity frequent meals – The best way to adapt to lifestyle post esophagectomy is to have small quantity of meals at least 6 to 7 times a day. This is because the stomach is now decreased in capacity but one can continue to eat all normal things as before but with reduced quantity. Hence to meet the requirements of the body one needs to eat less but more frequently.
• Don’t lie down immediately after eating – There needs to be a gap of 1 to 2 hours between your meal and sleep. This ensures that the food has passed from stomach to small intestine and will not regurgitate back into the chest.
• Chew your food well – Chew well as it ensures smooth passage through a newly constructed food pipe and through the anastomosis.
• Eat all that you want – Generally, patients can eat all they like to eat however some patients develop sweating, palpitations, bloating and diarrhea. This is called dumping syndrome and there is nothing to worry. Reduce the intake of high carbs and sugar in your diet and it will be fine.