Because esophageal cancer surgery changes the structure and function of your digestive tract, the question of when to eat, what to watch for in your diet, and what happens after you eat is a concern for doctors and patients alike.
Below, a brief answer to these common questions.
When should I take it?
Esophageal cancer surgery is a level 4 thoracic surgery with extensive surgical resection, many organs involved, long operation time, and great trauma. The surgery often imposes a large psychological burden on you and your family, leading to an overly cautious life. Even after a smooth recovery and when your doctor tells you that you can eat, you may still be afraid to eat through your mouth for fear that the esophagogastric anastomosis will be burst by food.
First, it is recommended that you trust your doctor. If your recovery from esophageal cancer goes well, the healing time for the esophagogastric anastomosis is about 2 weeks. Some doctors will give you an upper gastrointestinal iodography to confirm that the anastomosis is healing well and that the tube is emptying well after surgery. Only when the anastomosis has healed well will the doctor tell you that you can eat by mouth, so you can rest assured.
Second, anastomotic fistulas do occur in some patients after eating, but this is a very unlikely event. If an anastomotic fistula does occur, it is usually mild and does not cause serious complications, and most heal with enteral nutrition support.
If you are eager to eat early, or start eating too quickly, or overeat, these behaviors are also inappropriate.
What should I expect when I eat after surgery compared to before surgery?
Because most of the stomach (about 1/2) has been removed, the capacity of the stomach is reduced, so you should eat “smaller and more frequent” meals after surgery. If you eat a lot of food, it may cause reflux and even aspiration of the refluxed food into the lungs, which can cause severe pneumonia.
The most common problems that occur after eating are aspiration, swallowing discomfort, and anastomotic stenosis.
In a triple cervical-thoracic-abdominal incision, the muscles of the neck are damaged and the recurrent laryngeal nerve may be damaged during surgery, which can cause you to have uncoordinated swallowing movements after surgery, which can lead to aspiration of food into the airway. If this happens, then you should eat as slowly as possible with your head down and chew slowly when eating in the early postoperative period.
We recommend:
Patients with triple incision surgery should start with mucousy foods, such as yogurt and bananas, and gradually add a liquid diet and water after surgery.
Patients with two-incision and transabdominal resections can start with a liquid diet and water and gradually transition to a semifluid and universal diet.
When gradually adapted, there is not much restriction on the type of food eaten; fish, meat, eggs, etc. only need to be fully chewed.
What happens after eating?
Some patients still feel a sense of obstructive choking after eating, which is mainly due to the postoperative anastomotic scar. Most people can get better gradually after eating by the squeezing and expanding effect of the food as it passes through the anastomosis.
Some people feel difficulty swallowing for a long time after eating and have to come to the hospital. In this case, the cause can be clarified by iodine contrast examination of the upper gastrointestinal tract. Sometimes, gastroscopy reveals that whole pieces of food can even get stuck in the anastomotic position, which in severe cases can lead to narrowing of the anastomosis and require multiple dilation via gastroscopy.
If you often experience a feeling of fullness after a small amount of food after surgery, it may be due to the reduction in volume of the stomach after surgery when part of the stomach tissue was removed. It is recommended that you should eat smaller and more frequent meals, reducing the amount you eat at each meal and increasing the number of meals you eat. When you go out for a long time, you should carry a small amount of food with you to prevent hypoglycemia.
Some people will have nocturnal food reflux, mainly due to the surgical removal of the cardia, a structure that stops the reflux of stomach contents. Also, the postoperative lifting of the stomach into the chest cavity makes it easier to reflux food at night when sleeping flat on your back. To avoid food reflux at night as much as possible, we recommend that you avoid eating 2 hours before bedtime, move appropriately after dinner, and elevate the head of the bed 30 degrees in severe cases.
To summarize, the principles of postoperative diet are: eat small, frequent meals, chew slowly, and eat slowly. These steps can reduce the corresponding problems and prevent complications such as postoperative gastric emptying disorder and dumping syndrome.