About Your Esophagectomy Surgery

This guide will help you get ready for your esophagectomy surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.

Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery. Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.

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About Your Surgery

An esophagectomy is a surgery to remove part of your food pipe (esophagus). This is the tube that carries food from your mouth to your stomach (see Figure 1). Your surgeon may also remove part of your stomach to make sure all of the cancer is taken out. The remaining part of your stomach will be rebuilt and attached to what is left of your esophagus.

Figure 1. Your esophagus

Figure 1. Your esophagus

There are different ways to perform esophagectomy surgery. Your surgeon will talk with you about which one is best for you.

  • During an Ivor Lewis esophagectomy, also known as a transthoracic esophagogastrectomy, incisions (surgical cuts) are made in the center of your abdomen (belly) and in the back of your chest. After the tumor is removed, your stomach is reattached to the remaining part of your esophagus.
  • During a transhiatal esophagectomy, your esophagus is removed through 2 incisions, one in your neck and one in your abdomen. After the tumor is removed, your stomach is attached to the remaining part of your esophagus through the neck incision.
  • During a 3-hole esophagectomy, also known as McKeown esophagectomy, incisions are made in your abdomen, neck, and right upper back.
  • During a minimally invasive esophagectomy, a tiny camera called a laparoscope is inserted into your belly and chest through multiple small incisions in your abdomen and back, below your shoulder. A robot may be used to assist.

The length of your surgery depends on which type of surgery and which incisions you have.

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Before Your Surgery

The information in this section will help you get ready for your surgery. Read this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.

As you read through this section, write down any questions you want to ask your healthcare provider.

Quit smoking before your surgery

You’re considered a smoker if you have smoked, even a puff, or used any kind of tobacco product in the last 30 days. This include e-cigarettes, vaporizers, and other types of electronic nicotine delivery systems (ENDS). If you’re a smoker, you need to stop smoking 2 weeks before your surgery.

Quitting smoking will help you recover better after your surgery. Quitting will:

  • Help your heart and lungs work better
  • Reduce complications during and after your surgery
  • Help your wounds heal
  • Lower your need for rehabilitation to improve your breathing after surgery
  • Lower your risk of getting an infection after surgery

If you smoke, tell the nurse who works with your surgeon. They’ll refer to you our Tobacco Treatment Program. You can also reach the program by calling 212-610-0507.

If you’ve quit smoking, tell the nurse the date you quit and how much you smoked before you quit. They can refer you to our Tobacco Treatment Program to help you avoid starting to smoke again.

You don’t have to quit alone!
Call 212-610-0507 to talk with a Tobacco Treatment Specialist.

MSK’s Tobacco Treatment Program

Our Tobacco Treatment Program has a team of Tobacco Treatment Specialists (TTS) who can help you create a plan to quit smoking or stay quit. A TTS will call you to talk with you about the benefits of quitting smoking, especially before surgery.

The TTS may suggest nicotine replacement therapy medication (such as a nicotine patch, gum, lozenge, or inhaler) or cessation medication to help you quit safely and effectively. These medications:

  • Are safe to use before and after surgery
  • Can double your quitting success rate
  • Can help you feel more comfortable during a very stressful time

The TTS will also teach you practical skills to cope with your urges to smoke and help you find ways to manage nicotine withdrawal symptoms.

Getting ready for your surgery

You and your care team will work together to get ready for your surgery.

Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.

  • I take a blood thinner, such as:
    • Aspirin
    • Heparin
    • Warfarin (Jantoven® or Coumadin®)
    • Clopidogrel (Plavix®)
    • Enoxaparin (Lovenox®)
    • Dabigatran (Pradaxa®)
    • Apixaban (Eliquis®)
    • Rivaroxaban (Xarelto®)
    There are others, so be sure your healthcare provider knows all the medications you’re taking.
  • I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
  • I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
  • I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
  • I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
  • I have sleep apnea.
  • I’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.
  • I’m allergic to certain medication(s) or materials, including latex.
  • I’m not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke or use an electronic smoking device (such as a vape pen, e-cigarette, or Juul®).
  • I use recreational drugs.

About drinking alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

  • If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
  • If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

  • Be honest with your healthcare providers about how much alcohol you drink.
  • Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
  • Tell your healthcare provider if you can’t stop drinking.
  • Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.

About sleep apnea

Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.

Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device (such as a CPAP device) for sleep apnea, bring it with you the day of your surgery.

About benign prostate hyperplasia (BPH)

BPH is when your prostate gland is enlarged (bigger than normal). If you’re male, age 50 or older, and have a history of BPH, your surgeon will give you a prescription for doxazosin (Cardura®). Taking doxazosin before your surgery can help prevent problems with urination (peeing) after your procedure.

Start taking the doxazosin 3 days before your surgery.

About Enhanced Recovery After Surgery (ERAS)

ERAS is a program to help you get better faster after your surgery. As part of the ERAS program, it’s important to do certain things before and after your surgery.

Before your surgery, make sure you’re ready by doing the following things:

  • Read this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your healthcare provider at your next appointment, or you can call their office.
  • Exercise and follow a healthy diet. This will help get your body ready for your surgery.

After your surgery, help yourself recover more quickly by doing the following things:

  • Read your recovery pathway. This is a written educational resource that your healthcare provider will give you. It has goals for your recovery and will help you know what to do and expect on each day during your recovery.
  • Start moving around as soon as you can. The sooner you’re able to get out of bed and walk, the quicker you’ll be able to get back to your normal activities.

Within 30 days of your surgery

Presurgical Testing (PST)

Before your surgery, you’ll have an appointment for presurgical testing (PST). The date, time, and location will be printed on the appointment reminder from your surgeon’s office. It’s helpful to bring the following things to your PST appointment:

  • A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
  • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
  • The name(s) and telephone number(s) of your healthcare provider(s).

You can eat and take your usual medications the day of your appointment.

During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

Your NP will talk with you about which medications you should take the morning of your surgery.

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.

For caregivers

‌  Resources and support are available to help manage the responsibilities that come with caring for a person going through cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read A Guide for Caregivers.

Talk with a clinical dietitian nutritionist

A clinical dietitian nutritionist will contact you before your surgery. They’ll talk with you about the dietary (eating and drinking) changes you can expect after your surgery. They’ll also discuss the dietary guidelines you’ll need to follow while you’re recovering after surgery. For more information about the dietary changes you can expect after your surgery, read the resource Diet and Nutrition During Treatment for Esophageal Cancer.

Complete a Health Care Proxy form

If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. If you’ve already completed one or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent.

Talk with your healthcare provider if you’re interested in completing a health care proxy. You can also read the resources Advance Care Planning and How to Be a Health Care Agent for information about health care proxies, other advance directives, and being a health care agent.

Do breathing and coughing exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. For more information, read the resource How to Use Your Incentive Spirometer.

Exercise

Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center. Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Follow a healthy diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

Buy clear liquids

You’ll need to follow a clear liquid diet before your surgery. It’s helpful to buy clear liquids ahead of time. For a list of clear liquids you can drink, read the section “Follow a clear liquid diet.”

Buy a wedge pillow

Buy a 12-inch wedge pillow from your local pharmacy or health supply store. You’ll need this pillow when you go home after your surgery to keep your torso raised. It isn’t safe to lay flat after espohagectomy surgery.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Don’t stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.

3 days before your surgery

Start taking doxazosin, if needed

If your healthcare provider gave you a prescription for doxazosin, start taking it 3 days before your surgery. For more information, read the “About Benign Prostate Hyperplasia (BPH)” section.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. These medications can cause bleeding. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Follow a clear liquid diet

You’ll need to follow a clear liquid diet the day before your surgery. A clear liquid diet includes only liquids you can see through. You can find examples in the “Clear liquid diet” table.

While you’re following a clear liquid diet:

  • Don’t eat any solid foods.
  • Try to drink at least 1 (8-ounce) glass of clear liquid every hour while you’re awake.
  • Drink different types of clear liquids. Don’t just drink water, coffee, and tea.
  • Don’t drink sugar-free liquids unless you have diabetes and a member of your care team tells you to.
For people with diabetes

If you have diabetes, ask the healthcare provider who manages your diabetes what to do while you’re following a clear liquid diet.

  • If you take insulin or another medication for diabetes, ask if you need to change the dose.
  • Ask if you should drink sugar-free clear liquids.

Make sure to check your blood sugar level often while you’re following a clear liquid diet. If you have any questions, talk with your healthcare provider.

Clear liquid diet
  Drink Do Not Drink
Soups
  • Clear broth, bouillon, or consommé
  • Any products with pieces of dried food or seasoning
Sweets
  • Gelatin (such as Jell-O®)
  • Flavored ices
  • Hard candies (such as Life Savers®)
  • All others
Drinks
  • Clear fruit juices (such as lemonade, apple, cranberry, and grape juices)
  • Soda (such as ginger ale, 7UP®, Sprite®, and seltzer)
  • Sports drinks (such as Gatorade®)
  • Black coffee
  • Tea
  • Water
  • Juices with pulp
  • Nectars
  • Smoothies or shakes
  • Milk or cream
  • Alcoholic drinks

Note the time of your surgery

A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you on the Friday before. If you don’t get a call by 7:00 pm, call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

This will be the following location:

Presurgical Center (PSC) on the 6th floor
1275 York Avenue (between East 67th and East 68th Streets)
New York, NY 10065
B elevator to 6th floor

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.

  1. Use your normal shampoo to wash your hair. Rinse your head well.
  2. Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
  3. Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
  4. Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Don’t put it on your face or genital area.
  5. Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
  6. Dry yourself off with a clean towel after your shower.
  7. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Sleep

Go to bed early and get a full night’s sleep.

Instructions for eating before your surgery

‌  
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
 

The morning of your surgery

Instructions for drinking before your surgery

  • If your healthcare provider gave you a CF(Preop)® drink, finish it 2 hours before your scheduled arrival time. Do not drink anything else after midnight the night before your surgery, including water.
  • If your healthcare provider didn’t give you a CF(Preop) drink, you can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.

 
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take your medications as instructed

If your healthcare provider told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)

Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.

Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

  • Wear something comfortable and loose-fitting.
  • If you wear contact lenses, wear your glasses instead. -Wearing contact lenses during surgery can damage your eyes.
  • Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
  • Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
  • Remove nail polish and nail wraps.
  • Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
  • If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

  • This guide. Your healthcare team will use it to teach you how to care for yourself after surgery.
  • Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can fit over this swelling.
  • Your breathing device for sleep apnea (such as your CPAP device), if you have one.
  • Your Health Care Proxy form and other advance directives, if you completed them.
  • Your cell phone and charger.
  • A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
  • Your toothbrush and other toiletries, if you’d like.

Where to park

MSK's parking garage

MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.

There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

Once you’re in the hospital

When you get to the hospital, take the B elevator to the 6th floor. Check in at the desk in the PSC waiting room.

You’ll be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.

Get dressed for surgery

When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (including prescription and over-the-counter medications, patches, and creams) and the time you took them.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

  • Review your medical history with you.
  • Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
  • Talk with you about your comfort and safety during your surgery.
  • Talk with you about the kind of anesthesia you’ll get.
  • Answer your questions about your anesthesia.

Your doctor or anesthesiologist may also talk with you about placing an epidural catheter (thin, flexible tube) in your spine (back). An epidural catheter is another way to give you pain medication after your surgery.

Get ready for your surgery

When it’s time for your surgery, you’ll need to remove your hearing aids, dentures, prosthetic devices, wig, and religious articles, if you have them.

You’ll either walk into the operating room or a staff member will bring you there a stretcher. A member of the operating room team will help you onto the operating bed and place compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.

What to expect

After you’re asleep, a urinary (Foley) catheter may be placed to drain urine from your bladder. You may also have an arterial line (small catheter connected to a machine by a tube) placed in a blood vessel, usually in your arm or wrist. The arterial line will measure your blood pressure during your surgery.

Once your surgery is finished, your incisions will be closed with sutures (stitches) that will dissolve as you heal. You may also have Steri-Strips (thin pieces of surgical tape) or Dermabond® (surgical glue) over your incisions. Your incisions may be covered with a bandage.

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After Your Surgery

The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You’ll learn how to safely recover from your surgery.

As you read through this section, write down any questions you want to ask your healthcare provider.

In the Post-Anesthesia Care Unit (PACU)

When you wake up after your surgery, you’ll be in the PACU. A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You’ll also have compression boots on your lower legs.

You’ll have tubes and drains to help your body recover from the surgery. You may have the following:

  • A urinary catheter in your bladder to monitor the amount of urine you’re making.
  • 1 or 2 chest tubes attached to tubing that goes into a drainage device (see Figure 2).
  • A nasogastric tube (NG tube) in your nose. This tube goes down to your stomach to keep your stomach empty.
  • A jejunostomy tube (feeding tube) in your abdomen (belly). This tube goes into your small intestine to give you nutrition while you’re not able to eat.

You may have a pain pump called a patient-controlled analgesia (PCA) device. For more information, read Patient-Controlled Analgesia (PCA).

You may also have other tubes and drains. If you do, your nurse will explain why and take care of them while you’re in the hospital.

You’ll stay in the PACU overnight. 

In your hospital room

After your stay in the PACU, a staff member will take you to your hospital room. There, you’ll meet one of the nurses who will care for you while you’re in the hospital recovering from your surgery. Tell the nurse if you drink alcohol every day or if you’ve recently stopped drinking alcohol. Tell the nurse if you smoke or if you have recently quit smoking. They’ll offer you a nicotine replacement therapy to make you more comfortable while you’re in the hospital.

While you’re in the hospital, your healthcare providers will teach you how to care for yourself while you’re recovering from your surgery. Below are examples of ways you can help yourself recover safely.

  • Try to walk around after surgery. Walking every 2 hours is a good goal. This will help prevent blood clots in your legs and lower your risk of developing pneumonia (lung infection). You’ll have tubes and an IV line, so make sure you have help while you’re walking.
  • Use your incentive spirometer 10 times every hour while you’re awake. This will help your lungs expand, which prevents pneumonia. For more information, read How to Use Your Incentive Spirometer.
  • Do your breathing and coughing exercises every 1 to 2 hours while you’re awake.
  • Read the Esophagectomy Pathway resource. This resource explains what to expect and how to help your recovery while you’re in the hospital

Your nurse will also give you specific instructions for how to take care of your mouth. It’s important to keep your mouth clean to lower the risk of the bacteria in your mouth causing an infection.

Commonly asked questions: During your hospital stay

Will I have pain after my surgery?

You’ll have some pain after your surgery. Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.

You may get a prescription for pain medication before you leave the hospital. Talk with your healthcare provider about possible side effects and when you should start switching to over-the-counter pain medications.

Pain medication may cause constipation (having fewer bowel movements than usual). For more information, read the “How can I prevent constipation?” section below.

What is a chest tube?

Figure 2. A chest tube with a drainage device

Figure 2. A chest tube with a drainage device

A chest tube is a flexible tube that drains blood, fluid, and air from around your lung after surgery. The tube enters your body between your ribs and goes into the space between your chest wall and lung (see Figure 2).

When will my chest tube be removed?

Your chest tube will be removed once the drainage from your tube has stopped. After the tube is removed, the area will be covered with a bandage. Keep the bandage on for at least 48 hours, unless your nurse gives you other instructions.

Will I be able to eat?

You won’t be able to eat or drink right away. Your NG tube will keep your stomach empty and you’ll get nutrition through your feeding tube.

Around 3 days after your surgery, your NG tube may be removed. Around 5 days after your surgery, you may be able to start having sips of clear liquids. After that, you’ll slowly start drinking other liquids before you try eating soft foods.

Your doctor will talk with you about when it’s safe to start eating and drinking. Your nurse will give you information about how to eat and drink after your surgery and how to give yourself nutrition through your feeding tube.

You’ll also meet with an inpatient clinical dietitian nutritionist while you’re in the hospital. They’ll help you plan your diet both in the hospital and at home.

For more information about eating and drinking after surgery, read the resource Diet and Nutrition During Treatment for Esophageal Cancer.

Why is it important to walk?

Walking will help prevent blood clots in your legs. It also decreases your risk of having other complications, such as pneumonia. Walking 1 mile, which is 14 laps around the unit while you’re still in the hospital, is a good goal.

When will I leave the hospital?

How long you stay in the hospital depends on many things, such as the type of surgery you had and how you’re recovering. You’ll stay in the hospital until your doctor feels you’re ready to go home. Your nurse or doctor will tell you what day and time you can expect to be discharged.

Your doctor will talk with you if you need to stay in the hospital longer than planned. Examples of things that can cause you to stay in the hospital longer include:

  • Having an irregular heart rate
  • Having problems with your breathing
  • Having an infection

Commonly asked questions: At home

What is the Recovery Tracker?

We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12:00 am). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read the resource About Your Recovery Tracker .

Will I be able to eat when I go home?

Most people can drink clear liquids and get most of their nutrition through their feeding tube when they leave the hospital. Your doctor will tell you if you’ll be able to eat when you go home after surgery.

Your outpatient clinical dietitian nutritionist will help you switch from a clear liquid diet to a full liquid diet and, eventually, to a soft food diet. If you have a feeding tube, they’ll also tell you what kind of formula you’ll use when you go home. Your case manager will help you work with your insurance company to see what’s covered under your plan. Not all insurance companies will pay for formula.

The amount of nutrition you get from your feeding tube will change based on how much nutrition you get by eating and drinking. Your outpatient clinical dietitian nutritionist may ask you to keep a daily calorie log, keep track of how much you weigh, or both. For more information about eating and drinking after surgery, read the resource Diet and Nutrition During Treatment for Esophageal Cancer.

Will I have pain when I am home?

People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incision for 6 months or longer. This doesn’t mean something is wrong.

Follow the guidelines below to help manage your pain at home.

  • Take your medications as directed and as needed.
  • Call your healthcare provider if the medication prescribed for you doesn’t ease your pain.
  • Don’t drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy. Alcohol can make the drowsiness worse.
  • As your incision heals, you’ll have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) will ease aches and discomfort.
    • Follow your healthcare provider’s instructions for stopping your prescription pain medication.
    • Don’t take more of any medication than the amount directed on the label or as instructed by your healthcare provider.
    • Read the labels on all the medications you’re taking, especially if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Don’t take more than one medication that contains acetaminophen without talking with a member of your care team.
  • Pain medication should help you resume your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active.
  • Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Do the stretching exercises described in the “What exercises can I do?” section below. These will help to relieve the pain on the side of your surgery.

Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual). For more information, read the “How can I prevent constipation?” section below.

How do I care for my incisions?

You’ll have more than 1 incision after your surgery. The location of your incisions will depend on the type of surgery you had. There will be incisions from the surgical site and the chest tube. You may have some numbness below and in front of your incisions. You may also have some tingling and increased sensitivity around your incisions as they heal.

Surgical incision(s)
  • By the time you’re ready to leave the hospital, your surgical incision(s) will have started to heal.
  • Look at your incision(s) with your nurse before you leave the hospital so you know what they look like. This will help you know if there are any changes later.
  • If any fluid is draining from your incision(s), write down the amount, color, and if it has a smell.
  • If you go home with Steri-Strips or Dermabond on your incisions, they’ll loosen and fall off on their own. If they haven’t fallen off within 10 days, you can gently remove them.
  • If you have staples in your incision, they’ll be removed during your first appointment after surgery.
Chest tube incision
  • You may have some thin, yellow or pink-colored drainage from your incision. This is normal.
  • Keep your incision covered with a bandage for 48 hours after your chest tube is removed, unless the bandage gets wet. If it gets wet, change the bandage as soon as possible.
  • After 48 hours, if you don’t have any drainage, you can remove the bandage and keep your incision uncovered.
  • If you have drainage, keep wearing a bandage until the drainage stops. Change it at least once a day or more often if the bandage becomes wet.
  • Sometimes, the drainage may start again after it has stopped. This is normal. If this happens, cover the area with a bandage. Call your healthcare provider if you have questions.

How do I care for my feeding tube?

Every day, check for redness, swelling, or pus around your tube. If you see any of these things, call your doctor or NP.

If your feeding tube falls out, call your doctor’s office as soon as possible. They’ll give you instructions for putting the tube back in.

Clean the skin around your feeding tube

Clean the skin around your tube every day. For the first 2 days after your surgery, use iodine swab sticks to clean the skin. Starting on the third day after your surgery, use soap and water while you shower.

Follow the instructions below.

  1. Remove the old dressing.
  2. Clean the skin around your tube.
  3. Apply zinc oxide ointment.
  4. Cover the place where the tube enters your skin with a 4 x 4 gauze pad.
  5. Loop the tube and secure it with tape or a Cath-Secure® tab.
Flush your feeding tube

Flush your feeding tube once a day or as directed by your doctor. Follow the instructions below.

  1. Gather your supplies:
    • 60 mL syringe (syringe with catheter tip or an ENFit® syringe)
    • 60 mL of water (room-temperature or warm, plain tap water) in a cup
    • Paper towels
  2. Wash your hands with warm water and soap or use an alcohol-based hand sanitizer.
  3. Draw up 60 mL of water into the syringe.
  4. Place the paper towels under the Y-port at the end of the tube.
  5. Clamp the tube. Insert the syringe into the Y-port.
  6. Unclamp the tube. Gently push the plunger to inject the water.
  7. Re-clamp the tube. Remove the syringe from the Y-port.
  8. You can reuse your syringe. Rinse it in warm water and dry it with clean paper towels after each time your flush your tube.

If you’re having trouble flushing your tube, call your healthcare provider.

Can I shower?

You can shower 48 hours (2 days) after your chest tube is removed. Taking a warm shower is relaxing and can help decrease muscle aches.Remove your bandages and use soap to gently wash your incisions. Pat the areas dry with a towel after showering, and leave your incisions uncovered (unless there is drainage).

Don’t take tub baths until you discuss it with your doctor at the first appointment after your surgery.

How can I prevent constipation?

Your usual bowel pattern will change after surgery. You may have trouble passing stool (poop). Talk with your healthcare provider about how to prevent and manage constipation. You can also follow the guidelines below.

  • Both over-the-counter and prescription medications are available to treat constipation. Start with 1 of the following over-the-counter medications first:
    • Docusate sodium (Colace®) 100 mg. Take 3 capsules once a day. This is a stool softener that causes few side effects. Don’t take it with mineral oil.
    • Senna (Senokot®) 2 tablets at bedtime. This is a stimulant laxative, which can cause cramping.
  • If you feel bloated, avoid foods that can cause gas, such as beans, broccoli, onions, cabbage, and cauliflower.
  • If you haven’t had a bowel movement in 2 days, call your healthcare provider.

How can I help my recovery?

  • Exercise for at least 30 minutes each day. This will help you get stronger, feel better, and heal. Make a daily walk part of your routine.
  • Keep using your incentive spirometer and do your coughing and deep breathing exercises at home.
  • Use a humidifier in your bedroom during the winter months. Follow the directions for cleaning it. Change the water often.
  • Avoid contact with people with colds, sore throats, or the flu. These things can cause infection.
  • Don’t smoke. Smoking cigarettes is harmful to your health at any time, but it’s even more harmful as you’re healing after your surgery. Smoking causes the blood vessels in your body to become narrow. This decreases the amount of oxygen that reaches your wounds as they’re healing. Smoking can also cause problems with breathing and regular activities. It’s also important to avoid places that are smoky. Your nurse can give you information to help you deal with other smokers or situations where smoke is present. Remember, if you need help quitting, MSK’s Tobacco Treatment Program can help. Call 212-610-0507 to make an appointment.
  • Don’t drink alcohol, especially while you’re taking pain medication.

Can I resume my activities?

It’s important for you to resume your activities after surgery. Spread them out over the course of the day.

  • Walking and stair climbing are excellent forms of exercise. Gradually increase the distance you walk. Climb stairs slowly, resting or stopping as needed.
  • Do light household tasks. Try dusting, washing dishes, preparing light meals, and other activities as you’re able.
  • Use the arm and shoulder on the side of your surgery in all of your activities. For example, use them when you bathe, brush your hair, and reach up to a cabinet shelf. This will help restore full use of your arm and shoulder.
  • You can return to your usual sexual activity as soon as your incisions are well healed and you can do so without pain or fatigue.

Your body is an excellent guide for telling you when you’ve done too much. When you increase your activity, monitor your body’s reaction. You may find that you have more energy in the morning or the afternoon. Plan your activities for times of the day when you have more energy.

Is it normal to feel tired after surgery?

It’s common to have less energy than usual after your surgery. Recovery time is different for everyone. Increase your activities each day as much as you can. Always balance activity periods with rest periods. Rest is a vital part of your recovery.

How should I sleep after my surgery?

You’ll need to keep the head of your bed elevated with a wedge pillow after your surgery. It may take some time until your normal sleep pattern returns and you get used to the wedge pillow. Try not to nap during the day. Taking a shower before bed and taking your prescribed pain medications can also help.

When is it safe for me to drive?

You can start driving again after you have:

  • Regained full movement of the arm and shoulder on the side of your surgery.
  • Stopped taking narcotic pain medication (pain medication that may make you drowsy) for 24 hours.

Can I travel by plane?

Don’t travel by plane until your doctor says it’s okay. They’ll talk with you about this during your first appointment after your surgery.

When can I return to work?

The time it takes to return to work depends on the type of work you do, the type of surgery you had, and how fast your body heals. If you need a letter to go back to work, contact your healthcare provider.

When should I start doing arm and shoulder exercises?

Start doing arm and shoulder exercises as soon as your chest tube bandage is removed. This will help you to regain full arm and shoulder movement. To do the exercises, follow the instructions below. One of your healthcare providers will tell you how many times to repeat each exercise.

Axillary stretch
Figure 3. Axillary stretch

Figure 3. Axillary stretch

  1. Sit in a straight-backed chair with your feet flat on the floor.
  2. Clasp your hands together (see Figure 3).
  3. Lift your arms up and over your head.
  4. Slide your hands down to the back of your neck.
  5. Slowly twist the upper part of your body to the right side. Hold this position for 5 seconds while bringing your elbows as far back as possible.
  6. Return to the starting position.
  7. Slowly twist the upper part of your body to the left side. Hold this position for 5 seconds while bringing your elbows as far back as possible.
  8. Return to the starting position.
Towel stretch
Figure 4. Stretching up

Figure 4. Stretching up

 

Figure 5. Stretching back

Figure 5. Stretching back

  1. Stand comfortably with your feet about 6 inches apart.
  2. Put your arms in front of your body and hold 1 end of a hand towel in each hand (see Figure 4).
  3. Bring your arms over your head, straighten your elbows, and stretch toward your upper back. Do not arch your back and do not force the movement if it is difficult. Try to hold the position for 5 seconds.
  4. Relax and return to the starting position.
  5. Stand as in Step 1.
  6. Grasp the towel behind your back and lift upward as far as possible (see Figure 5). Be sure to stand straight. Try to hold the position for 5 seconds.
  7. Return to the starting position.

When can I start doing other kinds of exercise?

The best exercise is walking, climbing stairs, or doing another kind of aerobic exercise for at least 30 minutes each day. You can start doing this again right after your surgery, unless your healthcare provider gives you other instructions.

Don’t do heavy exercise or play contact sports until your doctor tells you it’s safe. When you start again, remember that it will take time for you to return to your previous level of activity. Start out slowly and increase your activity as you feel better.

When can I lift heavy objects?

Check with your doctor before you do any heavy lifting. Normally, you shouldn’t lift anything heavier than 10 pounds (4.5 kilograms) for at least 8 weeks after your surgery.

How can I cope with my feelings?

After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support.

The first step in coping is to talk about how you feel. Family and friends can help. Your healthcare providers can reassure, support, and guide you. It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. Many resources are available to you and your family. Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.

When is my first appointment after my surgery?

Your first appointment after surgery will be 1 to 3 weeks after you leave the hospital. Your nurse will give you instructions on how to make this appointment, including the phone number to call.

During this appointment, your healthcare provider will discuss your pathology results with you in detail.

You may also have appointments with other healthcare providers after your surgery. Use this space to write down information about other appointments, such as the type of appointment and when it should be scheduled.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to create their own account so they can see information about your care.

If you don’t have a MyMSK account, you can visit my.mskcc.org, call 646-227-2593, or call your doctor’s office for an enrollment ID to sign up. You can also watch our video How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. For help, contact the MyMSK Help Desk by emailing mymsk@mskcc.org or calling 800-248-0593.

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When to Call Your Healthcare Provider

Call your healthcare provider right away if:

  • Your feeding tube falls out
  • Your feeding tube becomes clogged
  • You have difficulty swallowing
  • You have nausea or vomiting
  • You have new or worsening shortness of breath
  • You have a fever of 101 °F (38.3 °C) or higher
  • You have pain that doesn’t get better with your medications
  • You have redness or swelling around your incisions
  • You have drainage from your incisions that smells bad or is thick or yellow (pus-like)
  • You don’t have any bowel movements for 3 days or longer
  • You notice any new symptom or physical change
  • You have any questions or concerns

Monday through Friday from 9:00 am to 5:00 pm, contact your healthcare provider’s office. After 5:00 pm, during the weekend, and on holidays, call 212-639-2000. Ask to speak to the thoracic doctor on call.

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Calorie Count Log

Every day, write down the things you eat and drink. You can use the Calorie Count Log in the printed version of this resource. Click “View and Print as PDF” in the right sidebar at the top of this webpage.

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Support Services

This section has a list of support services that may help you get ready for your surgery and recover safely.

As you read through this section, write down any questions you want to ask your healthcare provider.

MSK support groups

Virtual Programs: Esophageal Cancer
VirtualPrograms@mskcc.org
MSK offers a live, online support and education group for people who have had surgery for esophageal cancer. You can talk about issues that come up during and after treatment, share your experiences, and to provide practical and emotional support for others. Discussions are led by a social worker and a nurse.

MSK support services

For more online information, visit the Cancer Types section of www.mskcc.org.

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, including requesting a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.

Counseling Center
646-888-0200
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Female Sexual Medicine and Women’s Health Program
646-888-5076
Cancer and cancer treatments can have an impact on your sexual health. Our Female Sexual Medicine and Women’s Health Program can help if you’re dealing with cancer-related sexual health challenges such as premature menopause or fertility issues. Call for more information or to make an appointment. We can help you take action and address sexual health issues before, during, or after your treatment.

Food Pantry Program
646-888-8055
The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
646-888-0800
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Male Sexual and Reproductive Medicine Program
646-888-6024
Cancer and cancer treatments can have an impact on your sexual health. Our Male Sexual and Reproductive Medicine Program can help if you’re dealing with cancer-related sexual health challenges such as erectile dysfunction (ED). Call for information or to make an appointment. We can help you take action and address sexual health issues before, during, or after your treatment.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org

Patient and Caregiver Education
www.mskcc.org/pe
Visit the Patient and Caregiver Education website to search our virtual library. There you can find written educational resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
You may find it comforting to speak with someone who has been through a treatment like yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. These conversations are confidential. They may take place in person or over the phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nursing Office
212-639-6892
You may request private nurses or companions. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.

Social Work
212-639-7020
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call for information.

Virtual Programs
www.mskcc.org/vp
MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

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Educational Resources

This section has the educational resources mentioned in this guide. These resources will help you get ready for your surgery and recover safely after surgery.

As you read through these resources, write down any questions you want to ask your healthcare provider.

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