Cancer Surgery
Oesophageal and Gastric Cancer
Mr Antonios Athanasiou is an Oesophago-gastric Surgeon and has an extensive experience in performing oesophageal and gastric cancer surgery for both benign and malignant tumours. Patients from across the UK and overseas are regularly referred to Mr Antonios Athanasiou as he undertakes complex oesophageal and gastric cancer surgery.
What is an Oesophagectomy and Gastrectomy?
Oesophagectomy and gastrectomy is the surgical removal of a part or the entire organ and it is usually done for treatment of oesophageal or gastric tumours, both benign or malignant. The procedure may be performed through a traditional open procedure or using minimally invasive techniques.
The Oesophagus
The oesophagus and stomach are part of the upper gastrointestinal (GI) tract, which is part of the digestive system. The digestive system helps the body break down food and turn it into energy.
The oesophagus (food pipe or gullet) is a long, muscular tube that delivers food, fluids and saliva from the mouth and throat to the stomach. A valve (sphincter) at the end of the oesophagus stops acid and food moving from the stomach back into the oesophagus.
The Stomach
The stomach is a hollow, muscular organ in the upper left part of the abdomen, located between the end of the oesophagus and the beginning of the small bowel (small intestine). The stomach expands to store food that has been swallowed. It also helps with the absorption of some vitamins and minerals.
In the stomach, acidic (gastric) juices are released from glands in the stomach lining (mucosa). These juices break down food into a thick fluid, which then moves into the small bowel. In the small bowel, nutrients from the broken-down food are absorbed into the bloodstream.
Stomach Cancer
Stomach cancer begins from abnormal cells in the lining (mucosa) of the stomach. Tumours can begin anywhere in the stomach, although most start in the glandular tissue found on the stomach’s inner surface. This type of cancer is called adenocarcinoma of the stomach (also known as gastric cancer).
If not found and treated early, stomach cancer can spread through the lymphatic system to nearby lymph nodes or through the bloodstream to other parts of the body, such as the liver and lungs. It may also spread to the walls of the abdomen (peritoneum). Rarely, it can grow through the stomach wall into nearby organs such as the pancreas and bowel.
Oesophageal Cancer
Oesophageal cancer begins from abnormal cells in the innermost layer (mucosa) of the oesophagus. A tumour can start at any point along the length of the oesophagus.
The two main subtypes are:
Oesophageal squamous cell carcinoma.
This type of tumour starts in the thin, flat cells in the lining of the oesophagus, which are called squamous cells. It often begins in the middle and upper part of the oesophagus. In the UK, squamous cell carcinomas are less common than adenocarcinomas.
Oesophageal adenocarcinoma.
Barrett’s oesophagus occurs when the squamous cells lining the lower section of the oesophagus change into glandular cells. A tumour that starts in glandular cells is called an adenocarcinoma.
Adenocarcinomas are now the most common form of oesophageal cancer in the UK. If it is not found and treated early, oesophageal cancer can spread through the lymphatic system to nearby lymph nodes or through the bloodstream to other parts of the body, most commonly the liver. It can also grow through the oesophageal wall and invade the windpipe and lungs.
How does surgery help?
Surgery to remove some or most of the esophagus is called an esophagectomy. If the cancer has not yet spread far beyond the esophagus, removing the esophagus (and nearby lymph nodes) may cure the cancer. Often a small part of the stomach is removed as well. The upper part of the oesophagus is then connected to the remaining part of the stomach. Part of the stomach is pulled up into the chest or neck to become the new oesophagus.
Oesophagectomy can be performed open or minimally invasive. Because it uses smaller incisions, minimally invasive oesophagectomy may allow the patient to leave the hospital sooner, have less blood loss, and recover faster. Often, surgery is combined with chemotherapy or other treatments to make the surgery more successful.
An important decision is when to do the surgery and whether to add extra treatments before or after surgery. Many patients who in the past would have been considered to have inoperable disease can now be offered surgery.
What are the chances of success?
These days is very rare for patients to undergo surgery without a significant chance of success. A pre-operative assessment using the appropriate investigation, such as endoscopy, CT, and PET-CT scans, help to make sure that patients undergo surgery with a good chance of cure or at least many extra years of better quality of life.
Mr Athanasiou will provide you with an experienced and honest account of the options, risks and benefits of advanced laparoscopic or open surgery, putting your safety and well-being as the first priority. By focusing on preoperative care and postoperative recovery we will improve the outcome of your operation.