Dr. Dwarakanath Reddy Surgical Gastroenterology

Procedure · GI Oncology

Esophageal cancer surgery, major resection done well

Ivor Lewis · McKeown · Transhiatal · Apollo Speciality Hospitals, Nellore

Esophageal cancer surgery is one of the most demanding GI cancer operations. Outcomes depend on careful patient selection, neoadjuvant therapy where indicated, and the experience of the operating team. Dr. Dwarakanath Reddy performs esophagectomy with two-field lymphadenectomy at Apollo Speciality Hospitals, Nellore, with multidisciplinary tumour-board planning on every case.

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01 · GI Oncology

What is esophageal cancer surgery?

Esophagectomy is the removal of all or part of the esophagus along with surrounding lymph nodes, and reconstruction of the digestive tract, usually using the stomach, occasionally with colon or jejunum. The operation has three main approaches: Ivor Lewis (right thoracotomy plus laparotomy), McKeown (three-field, abdomen, chest, and neck), and transhiatal (abdomen and neck only). Each has specific indications based on tumour location, stage, and patient anatomy. Most cases are now performed using minimally invasive (thoracoscopic plus laparoscopic) or hybrid approaches.

02 · GI Oncology

Conditions treated

Surgery is offered for:

  • Esophageal squamous cell carcinoma, the most common type in India
  • Esophageal adenocarcinoma, typically lower esophagus, often arising from Barrett's
  • Gastro-esophageal junction (GEJ) cancers (Siewert classification)
  • Esophageal high-grade dysplasia not amenable to endoscopic management
  • Selected esophageal GIST tumours
  • End-stage achalasia with sigmoid esophagus

Workup includes upper GI endoscopy with biopsy, contrast CT, PET-CT, endoscopic ultrasound (EUS), and bronchoscopy in selected cases. Multidisciplinary tumour board discussion is mandatory before any surgery.

03 · GI Oncology

How an Ivor Lewis esophagectomy is performed

  1. 01 First abdominal phase: gastric mobilisation, lymph node dissection, formation of the gastric conduit
  2. 02 Second thoracic phase via right thoracotomy or thoracoscopy: full mobilisation of the esophagus with two-field lymphadenectomy
  3. 03 Resection of the esophagus along with the proximal stomach
  4. 04 Pull-up of the gastric conduit into the chest
  5. 05 Stapled or hand-sewn intrathoracic anastomosis between the conduit and remaining esophagus
  6. 06 Drains placed in the chest and abdomen

Total operating time is 5 to 8 hours. The McKeown three-field approach is preferred for upper-thoracic tumours; transhiatal is used in selected lower-third tumours. Most patients receive neoadjuvant chemoradiotherapy beforehand.

04 · GI Oncology

Recovery timeline

Day of surgery Inpatient ICU. NPO. Ventilatory support overnight in some cases.
Day 1 to 4 Step-down from ICU when stable. Sips of fluid not started until contrast study confirms anastomotic integrity around day 4 to 7.
Day 5 to 14 Liquid then soft diet. Drains removed progressively. Most patients discharged around day 10 to 14.
Week 3 to 8 Soft diet at home, small frequent meals. Office work usually deferred for 6 to 8 weeks.
Month 3 onward Adjuvant therapy considered based on histopathology. Surveillance imaging every 3 months for the first 2 years.

Eating after esophagectomy requires adjustment, small, frequent meals, slow chewing, sitting up for 30 to 45 minutes after each meal to prevent reflux. Most patients lose 5 to 10 kg in the first 3 months and stabilise at 6 to 12 months. A nutritionist's input is part of the recovery plan.

05 · GI Oncology

Risks and complications

Esophagectomy is one of the highest-risk GI cancer operations. Specific risks include anastomotic leak (5 to 15 percent, varies by approach and technique), pulmonary complications (pneumonia, ARDS), recurrent laryngeal nerve injury (causing voice change), chyle leak, and longer-term issues with reflux and dietary tolerance. Operative mortality at high-volume centres is 2 to 5 percent. Dr. Reddy discusses individual risk and expected outcomes openly during pre-operative counselling.

06 · GI Oncology

Why Dr. Reddy for esophageal cancer surgery

  • DrNB qualified surgical gastroenterologist with focused upper GI oncology training
  • Two-field lymphadenectomy as standard for thoracic esophageal cancers
  • Minimally invasive or hybrid approach where oncologically appropriate
  • Apollo Speciality Hospitals, high-end ICU with thoracic anaesthesia, blood bank, ventilatory and dialysis backup
  • Tumour-board format discussion on every case with medical and radiation oncology

07 · GI Oncology

Frequently asked questions

Will I need chemotherapy or radiation before surgery?
Most locally advanced thoracic esophageal cancers benefit from neoadjuvant chemoradiotherapy (the CROSS regimen, 5 weeks of treatment) before surgery. Some adenocarcinomas of the lower esophagus and junction are treated with perioperative chemotherapy (FLOT regimen) instead. The decision is made in tumour board after staging is complete.
How long after radiation can surgery happen?
Surgery is typically scheduled 6 to 10 weeks after the end of neoadjuvant chemoradiotherapy. This window allows treatment-related inflammation to settle and assessment of response to be completed.
Will I be able to eat normally after esophagectomy?
Eating patterns change significantly. Most patients eat small, frequent meals (6 to 8 a day) rather than three large ones. Patients sit upright for 30 to 45 minutes after meals to reduce reflux. Most adapt well within 6 to 12 months, though some dietary modifications remain permanent.
What is the survival rate for esophageal cancer after surgery?
Stage dependent. Early stage (T1, T2) with clear nodes has 5-year survival above 60 to 70 percent. Locally advanced (T3 or with positive nodes) treated with neoadjuvant therapy and surgery is 30 to 50 percent. Stage IV is generally not curable surgically. Outcomes have improved substantially with neoadjuvant therapy and improved peri-operative care.
Will my insurance cover this surgery?
Yes. Esophageal cancer surgery is universally covered by major insurers. Send your imaging and biopsy report on WhatsApp for a pre-authorisation estimate.
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Related conditions

Conditions this procedure treats.

ICD-10 · C15

Esophageal Cancer

Cancer of the oesophagus (food pipe), either squamous cell carcinoma (more common in India) or adenocarcinoma (more common in lower oesophagus, often arising from Barrett's). Curative treatment combines chemoradiotherapy and esophagectomy.

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Next step

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