Problems after surgery for oesophageal cancer

There is a risk of problems or complications after any operation.

Some complications can happen straight after surgery when you're in hospital. Or you might have problems after you go home.

Possible problems after oesophageal cancer surgery include difficulty eating, or a leak where the surgeon joins the oesophagus to the stomach or the bowel. Other risks include infection, blood clots and bleeding. 

Many problems are minor but some can be life threatening. Treating them as soon as possible is important.

Risks after surgery

After any major operation there is a risk of: 

Infection

You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You will have antibiotics to reduce the risk of developing an infection after surgery. Tell your doctor or nurse if you have any symptoms of infection. If you have these symptoms when back at home, call your 24 hours advice line.

They include:

• a change in your temperature – 37.5°C or higher or below 36°C
• shivering
• feeling hot and cold
• feeling generally unwell
• cough
• feeling sick
• swelling or redness around your wound and your wound might feel hot
• a strong smell or liquid oozing from your wound
• loss of appetite

Rarely for an infection in your wound, you may need another operation.

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage there (a pulmonary embolism). Symptoms include:

• shortness of breath

• chest pain

• coughing up blood

• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Bleeding

There is a risk that you will bleed after your operation. The team looking after you will monitor you closely for signs of bleeding. The treatment you need depends on what is causing the bleeding and how much blood you lose. You might need a blood transfusion.

Risks after oesophageal cancer surgery

There are some complications that can happen in the first few hours or days after your oesophageal cancer surgery. Your team will keep a close eye on you to look out for these problems. 

A leak where the oesophagus joins the stomach

Leaks can happen where the surgeon joins the oesophagus to the stomach or the bowel. This is called an anastomotic leak. This is a serious problem and you need to have treatment straight away.

Treatment includes:

• stopping eating and drinking
• antibiotics
• draining the leak
• tube feeding

You will have endoscopies and scans to check that it is healing. You might need more surgery to repair the leak if the other treatments don’t work. You need to stay in hospital longer if you have a leak.

Around 6 out of 100 people (6%) have a leak after this surgery. This is most likely to happen in the first week after surgery. It is extremely rare for people to have a leak after they have gone home.

Tell your doctor or nurse if you have any breathlessness or severe chest pain.

Breathlessness

Chest infections, including pneumonia, can be serious. 

You can lower your risk by:

• stopping smoking before your operation
• getting up and moving as soon as possible after your operation
• doing any breathing exercises your physiotherapist teaches you

If you get an infection you have antibiotics to treat it. 

Heart problems

Some people have heart problems after this surgery. This can cause problems with other organs, including your kidneys. You’ll have regular blood tests to check how well your heart and kidneys work.  

Voice changes

You may have voice changes after your operation, including hoarseness. This happens if the nerve that connects to the voice box is damaged during your operation.

This is usually temporary because of bruising. More rarely it can be permanent. Even more rarely people need surgery to repair their vocal cords.

Thoracic duct or chyle leak

The thoracic duct is a tube close to the oesophagus. It is part of the lymphatic system. During your operation, your surgeon may divide it. Rarely, it leaks after your operation. This is most likely to happen in the first week after surgery.

The main symptom is more fluid draining into your chest drain than your doctor would expect.

Rarer symptoms include pain and feeling breathless.

Treatment is to drain the fluid. You might need to have another tube put into the area where the fluid is collecting. You might need to have an operation to repair it if the duct doesn’t repair itself.

Contact your doctor if you have any symptoms.

Other problems after you go home

Some complications might cause you problems after you go home. You will have regular follow up appointments with your surgeon. They will check whether you have any problems.  

Contact your doctor or specialist nurse if you have any concerns between appointments.  You don’t have to wait until your next visit.

Weakness and lacking in strength

Most people feel weak and lack strength for some time afterwards. How long this lasts varies between people.

Tell your doctor or nurse if the weakness continues for more than a few weeks. They can suggest things to help, such as physiotherapy.

Eating problems

Most people have some problems eating after surgery. This can cause weight loss. You might have a feeding tube when you go home. This is to give you extra nutrients if you need them.

You’ll usually be able to eat normally again in a few months. For some people it takes up to 2 years. And there might be some foods you will always need to avoid.

You might also have tummy (abdominal) discomfort and diarrhoea after certain foods. The combination of these symptoms is called dumping syndrome.

Eating small amounts regularly is important. Tell your dietitian about any problems you have with eating.

Slow emptying of your stomach and reflux

Surgery can cause a problem with the contents of the stomach going back into the oesophagus (reflux).

Reflux can cause symptoms such as heartburn. Treatment includes:

• antacids
• medicines that help to move food through the stomach and bowel