Oesophagectomy
Removal of part or all of the food pipe (oesophagus), usually for oesophageal cancer.
What to expect
Your Journey
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Before surgery
Your preparation usually begins 4–8 weeks before surgery with a pre-assessment clinic visit for blood tests, a heart trace (ECG), and a medication review. At Wellington Hospital specifically, you'll also be seen in the high-risk clinic or CHRISP clinic alongside your surgical clinic, where you'll be given education and resources for the weeks ahead. You may be referred to a physiotherapist for a prehabilitation programme and to a dietitian, as good nutrition before this operation significantly improves your recovery. If chemotherapy or radiotherapy is part of your treatment plan, surgery follows once that course is complete.
Because an oesophagectomy involves a long hospital stay and a higher than average risk of complications, your fitness for surgery is carefully assessed. This often includes special tests of your heart, lungs, and sometimes your cognition. One of these is a CPET test, where you ride a stationary bike while your breathing and heart are measured. It helps predict how well you're likely to cope with the surgery and its possible complications.
Occasionally, these results lead you, your surgeon, and your anaesthetist to decide together that surgery isn't the right option.
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The day of surgery
You'll be admitted on the morning of surgery. The operation is performed under general anaesthesia and takes approximately 8 hours. There are two main surgical approaches: minimally invasive oesophagectomy (MIO), done by keyhole, or open oesophagectomy (Ivor-Lewis), done through a larger incision.
Pain relief is planned around which approach you have. For MIO, this is usually a spinal anaesthetic alongside your general anaesthetic, delivering morphine into the spinal fluid, backed up by local anaesthetic catheters and a patient-controlled analgesia (PCA) pump after surgery. For open surgery, an epidural is more commonly used instead. Both spinals and epidurals are placed in theatre while you're awake and sitting up, before you go under general anaesthesia.
During the operation, monitoring lines are placed in an artery in your wrist and a vein in your neck, so the team can monitor you closely and give medications safely. These stay in until you no longer need them, and are removed during your hospital stay. Afterwards, you'll wake in the Post Anaesthesia Care Unit (PACU) and move to the high dependency unit (HDU), or wake directly in the intensive care unit (ICU), depending on your operation and recovery.
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In hospital
You'll spend 1 to 2 days in ICU or HDU before moving to the surgical ward. Initially you'll have a chest drain, a feeding tube into your small intestine, and a tube through your nose to keep your new stomach connection resting. A dietitian will guide your gradual return to eating.
A physiotherapist and the ward nurses will help you sit up and walk from day one, which is one of the most important things you can do for your recovery. Keep doing the breathing exercises you practised before surgery.
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Going home
Most patients go home after 7 to 14 days, eating soft or modified foods. This usually continues for several weeks as your body adjusts. Your team will give you clear written guidance on diet and wound care before you leave, and a follow-up appointment is usually 2 to 4 weeks after discharge.
Contact your surgical team straight away if you develop a fever, difficulty swallowing, new chest pain, or any concerns about your wound.
The people around you
Who looks after you
A lot of people are involved in getting you safely through an operation. Knowing who does what can make the whole experience feel less unfamiliar.
Your anaesthetist
Anaesthetists are specialist doctors who are trained in anaesthesia, pain management, and the care of seriously unwell patients. You will meet yours before the operation: they will go through your health, explain the plan, and answer any questions.
During surgery, your anaesthetist stays with you the whole time. They give the medications that keep you under anaesthesia and free of pain, and continuously monitor your breathing, heart, blood pressure, and fluids as the operation is happening. Afterwards they plan your pain relief, so you can breathe deeply, move, and recover. If you are worried about anything at all, tell them. Helping you through this safely and comfortably is their entire job.
Your surgeon
Surgeons are specialist doctors. You will usually meet yours first in clinic, to talk through whether surgery might be a helpful treatment option, what the risks are, and what happens if you choose not to have an operation. Sometimes an anaesthetist and other specialists are involved in these decisions too. Your surgeon performs your operation, and after surgery their team looks after you on the ward and plans your follow-up.
Pre-assessment nurse
Sees you in the weeks before surgery to review your health, medications, and test results, and to make sure everything is ready for the day. A good person to ask early questions.
Anaesthetic technician
A specially trained member of the theatre team who works alongside your anaesthetist, preparing and checking equipment and helping care for you throughout the operation.
Theatre and PACU nurses
Theatre nurses help to look after you, assist the surgeons, manage surgical equipment, and ensure everything runs smoothly. In the Post Anaesthesia Care Unit (PACU), specialised nurses monitor you closely as you wake and treat pain or nausea straight away.
Ward nurses
Your day-to-day carers in hospital: medications, wound care, and keeping an eye on your progress. They are your first port of call whenever something doesn't feel right.
Physiotherapist
Helps you recover movement and function after surgery. What this looks like depends on your operation: it might be breathing exercises to protect your lungs, joint exercises after a replacement, or simply helping you walk safely again. Getting moving is one of the most important parts of recovery, and they will guide you from your first steps out of bed.
Hospital pharmacist
Checks your medicines when you arrive and when you leave, making sure nothing is missed and your discharge medications are right.
Cultural and pastoral support
Most hospitals offer support for you and your whānau throughout your stay, including Māori and Pacific health services and chaplaincy for all faiths and none. Ask any staff member for a referral.
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