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.

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

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 through this section when your surgery is scheduled and refer to it as your surgery date gets closer. It contains important information about what you need to do before your surgery.

Write down your questions and be sure to ask your doctor or nurse.

Getting Ready for Your Surgery

You and your healthcare team will work together to prepare 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. Some examples are aspirin, heparin, warfarin (Coumadin®), clopidogrel (Plavix®), enoxaparin (Lovenox®), dabigatran (Pradaxa®), apixaban (Eliquis®), and rivaroxaban (Xarelto®). There are others, so be sure your healthcare provider knows all the medications you’re taking.
  • I take prescription medications (medications prescribed by a healthcare provider), 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 have had a problem with anesthesia (medication to make you sleep during surgery) in the past.
  • I am allergic to certain medication(s) or materials, including latex.
  • I am not willing to receive a blood transfusion.
  • I drink alcohol.
  • I smoke.
  • I use recreational drugs.

Quit Smoking before 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 will refer to you our Tobacco Treatment Program. You can also reach the program at 212-610-0507.

If you have 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 keep from starting to smoke again.

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 contact you on the phone and talk with you about the benefits of quitting smoking, especially before surgery.

You Don’t Have to Quit Alone!

To speak with a Tobacco Treatment Specialist, call 212-610-0507

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.

    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, the 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.

    About Benign Prostate Hyperplasia (BPH)

    BPH is when your prostate gland is enlarged. If you are a male, 50 years of age or older, and have a history of BPH, your doctor will give you a prescription for doxazosin (Cardura®). Taking doxazosin before your surgery can help prevent problems with urination 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 doctor or nurse at your next appointment, or you can call your doctor’s 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. Your nurse will give you a pathway with goals for your recovery. It 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 will be able to get back to your normal activities.

    Within 30 Days of Your Surgery

    Presurgical Testing (PST)

    Before your surgery, you will have an appointment for presurgical testing (PST). The date, time, and location of your PST appointment will be printed on the appointment reminder from your surgeon’s office.

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

    During your appointment, you will meet with a nurse practitioner (NP) who works closely with anesthesiology staff (doctors and specialized nurses who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You will have tests, including 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.

    It’s very 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).

    Talk with a Clinical Dietitian Nutritionist

    A clinical dietitian nutritionist will contact you before your surgery. They will talk with you about the dietary (eating and drinking) changes you can expect after your surgery. They will also discuss the dietary guidelines you will 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. 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. For more information about health care proxies and other advance directives, read the resource Advance Care Planning.

    If you’re interested in completing a Health Care Proxy form, talk with your nurse. If you have completed one already, or if you have any other advance directives, bring them to your next appointment.

    Do Breathing and Coughing Exercises

    Practice taking deep breaths and coughing before your surgery. You will be given an incentive spirometer to help expand your lungs. For more information, read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.

    Exercise

    Try to do aerobic exercise, such as walking, swimming, or biking, for 30 minutes to an hour every day. If it’s cold outside, use stairs in your home or go to a mall or shopping market. 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, have trouble swallowing, or have a hard time maintaining your weight, talk with your doctor or nurse about meeting with a clinical dietitian nutritionist.

    10 Days Before Your Surgery

    Stop Taking Vitamin E

    If you take vitamin E, stop taking it 10 days before your surgery. Vitamin E can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

    Buy Hibiclens® Skin Cleanser

    Hibiclens skin cleanser

    Hibiclens is a skin cleanser that kills germs for 24 hours after you use it (see figure). Showering with Hibiclens before your surgery will help lower your risk of infection after surgery. You can buy Hibiclens at your local pharmacy without a prescription.

    Buy Clear Liquids

    You will need to follow a clear liquid diet before your surgery. Now is a good time to buy your supplies. 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 will 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

    Stop Taking Certain Medications

    If you take aspirin, ask your doctor if you should keep taking it. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

    Stop Taking Herbal Remedies and Other Supplements

    Stop taking herbal remedies and other dietary supplements 7 days before your surgery. If you take a multivitamin, ask your doctor or nurse if you should keep taking it. For more information, read Herbal Remedies and Cancer Treatment.

    Watch a Virtual Tour

    This video will give you an idea of what to expect when you come to Memorial Hospital (MSK’s main hospital) on the day of your surgery.

    3 Days Before Your Surgery

    Start Taking Doxazosin, If Your Doctor Told You To

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

    2 Days Before Your Surgery

    Stop Taking Certain Medications

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

    1 Day Before Your Surgery

    Follow a Clear Liquid Diet

    For People with Diabetes

    If you have diabetes, ask the healthcare provider who manages your diabetes what you should 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.

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

    You will need to follow a clear liquid diet the day before your surgery. A clear liquid diet includes only liquids you can see through. Examples are listed in the “Clear Liquid Diet” table.

    While you’re following this 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 plenty of liquids other than water, coffee, and tea.
    • Don’t drink sugar-free liquids unless you have diabetes.
    Clear Liquid Diet
      Drink Do Not Drink
    Soups
    • Clear broth, bouillon, or consommé
    • Any products with particles 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 juice)
    • Soda (such as ginger ale, 7-Up®, Sprite®, and seltzer)
    • Sports drinks (such as Gatorade®)
    • Black coffee
    • Tea
    • Water
    • Juices with pulp
    • Nectars
    • 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 will call you on the Friday before. If you don’t get a call by 7:00 pm, please call 212-639-5014.

    The staff member will tell you what time to arrive at the hospital for your surgery. They will also tell 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 Hibiclens

    The night before your surgery, shower using Hibiclens.

    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 Hibiclens bottle. Pour some solution into your hand or a washcloth.
    4. Move away from the shower stream to avoid rinsing off the Hibiclens too soon.
    5. Rub the Hibiclens gently over your body from your neck to your feet. Don’t put the Hibiclens on your face or genital area.
    6. Move back into the shower stream to rinse off the Hibiclens. Use warm water.
    7. Dry yourself off with a clean towel after your shower.
    8. 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.

     

    Do not eat or drink after midnight.

    The Morning of Your Surgery

      Two hours before your scheduled arrival time, drink the ClearFast PreOp® drink your nurse gave you.

    After you finish the ClearFast, do not eat or drink anything else. This includes water, hard candy, and gum.

    Take Your Medications

    If your doctor or NP 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 and the surgery you’re having, this may be all, some, or none of your usual morning medications.

    Shower With Hibiclens

    Shower using Hibiclens just before you leave for the hospital. Use the Hibiclens 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.
    • Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
    • Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.

    What to Bring

    • This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
    • Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can accomodate this swelling.
    • Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
    • Your Health Care Proxy form, if you have completed one.
    • 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 wish.

    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

    You will 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 will get a hospital gown, robe, and nonskid socks to wear.

    Meet With Your Nurse

    You will meet with your nurse before surgery. Tell them the dose of any medications (including patches and creams) you took after midnight and the time you took them.

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

    Meet With Your Anesthesiologist

    Your anesthesiologist 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 will have.
    • 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

    Once your nurse has seen you, 1 or 2 visitors can keep you company as you wait for your surgery to start. When it’s time for your surgery, your visitor(s) will be taken to the waiting area. Your visitors should read the resource Information for Family and Friends for the Day of Surgery.

    You will either walk into the operating room or be taken in on a stretcher. A member of the operating room team will help you onto the operating bed. Compression boots will be placed 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 will fall asleep. You will also get fluids through your IV line during and after your surgery.

    What to Expect

    After you’re asleep, you will have a urinary (Foley®) catheter placed to drain urine from your bladder. You may also have an arterial line (needle 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 will learn how to safely recover from your surgery.

    Write down your questions and be sure to ask your doctor or nurse.

    In the Post-Anesthesia Care Unit (PACU)

    When you wake up after your surgery, you will be in the Post Anesthesia Care Unit (PACU).

    A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You will get oxygen through a thin tube that rests below your nose called a nasal cannula. You will also have compression boots on your lower legs.

    You will 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.

    Your visitors can see you briefly in the PACU, usually within 90 minutes after you arrive there. A member of the nursing staff will explain the guidelines to them.

    You will stay in the PACU overnight. Your visitors won’t be able to stay at your bedside overnight, but they will be able to visit you during the night.

    In Your Hospital Room

    After your stay in the PACU, you will be taken to your hospital room. There, you will 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 smoke or if you have recently quit smoking. They will offer you a nicotine replacement therapy to make you more comfortable while you’re in the hospital.

    Your nurse will explain the best way to recover 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. You will 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 will have some pain after your surgery. Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your doctor or nurse. 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 doctor or nurse 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 what’s normal for you). 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

    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 will 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 will 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 will also meet with an inpatient clinical dietitian nutritionist while you’re in the hospital. They will 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 can I have visitors?

    You can have visitors between 8:00 am and 10:00 pm every day.

    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 will 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

    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 will 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 will also tell you what kind of formula you will 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?

    The length of time each person has pain or discomfort varies. You may still have some pain when you go home and will probably be taking pain medication. Some people may have soreness around their incision, tightness, or muscle aches for 6 months or longer. This doesn’t mean that something is wrong. Follow the guidelines below.

    • Take your medications as directed and as needed.
    • Call your doctor if the medication prescribed for you doesn’t relieve your pain.
    • Don’t drive or drink alcohol while you’re taking prescription pain medication.
    • As your incisions heal, you will have less pain and need less pain medication. A mild pain medication such as acetaminophen (Tylenol®) or ibuprofen (Advil®) will relieve aches and discomfort.
      • Don’t stop taking your pain medication suddenly. Follow your doctor or nurse’s instructions for stopping.
      • Don’t take more acetaminophen than the amount directed on the bottle or as instructed by your doctor or nurse. Taking too much acetaminophen can harm your liver.
    • Pain medication should help you as you resume your normal activities. Take enough medication to do your exercises comfortably. However, it’s normal for your pain to increase slightly as you increase your level of activity.
    • Keep track of when you take your pain medication. It’s most effective 30 to 45 minutes after taking it. Taking it when your pain first begins is more effective 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.

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

    How do I care for my incisions?

    You will 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 will 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 will 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 doctor’s office 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 will 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 doctor or nurse.

    Can I shower?

    You can shower 48 hours 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 (feces). Talk with your nurse about how to manage constipation.

    • 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 doctor or nurse.

    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 the machine. 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. It is even more so 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 may 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 have 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 will 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 begin 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. You will talk 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 doctor’s office.

    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.

    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.

    Repeat _______

    Towel Stretch
    Figure 4. Stretching up

     

    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.

    Repeat ______

    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 doctor or nurse 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 nurse, doctor, and social worker can reassure, support, and guide you. It’s always a good idea to let these professionals know how you, your family, and your friends are feeling emotionally. Whether you’re in the hospital or at home, the nurses, doctors, and social workers are 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 doctor will discuss your pathology results with you in detail.

    You may also have appointments with other doctors 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.

    MyMSK

    MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your healthcare team, view your test results, see your appointment dates and times, and more.

    If you don’t already have a MyMSK account, you can sign up by going to my.mskcc.org. For more information about signing up for a MyMSK account, watch our video How to Enroll in the Patient Portal: MyMSK. You can also contact the MyMSK Help Desk at by emailing mymsk@mskcc.org or calling 800-248-0593.

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    Contact Your Doctor or Nurse 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 temperature 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

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

    Write down your questions and be sure to ask your doctor or nurse.

    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

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

    Blood Donor Room
    212-639-7643
    Call for more 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.

    Chaplaincy Service
    212-639-5982
    At MSK, our chaplains 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. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.

    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.

    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.

    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.

    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 Support Program
    212-639-5007
    You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient and Caregiver Support Program, you’re able to speak with former patients and caregivers. These conversations may take place in person, over the phone, or through email.

    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.

    Sexual Health Programs
    Cancer and cancer treatments can have an impact on your sexual health. MSK’s Sexual Health Programs can help you take action and address sexual health issues before, during, or after your treatment.

    • Our Female Sexual Medicine and Women’s Health Program helps women who are dealing with cancer-related sexual health challenges, including premature menopause and fertility issues. For more information, or to make an appointment, call 646-888-5076.
    • Our Male Sexual and Reproductive Medicine Program helps men who are dealing with cancer-related sexual health challenges, including erectile dysfunction. For more information, or to make an appointment, call 646-888-6024.

    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.

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

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

    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.

    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 contains the educational resources that were referred to throughout this guide. These resources will help you get ready for your surgery and recover safely after surgery.

    Write down your questions and be sure to ask your doctor or nurse.

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