Esophagus Cancer Surgery

The esophagus (oesophagus) is a muscular tube in the chest. It's about 10 inches (25 centimeters) long. This organ is part of the digestive tract. Food moves from the mouth through the esophagus to the stomach.

Esophagus Cancer Surgery

The wall of the esophagus has several layers:

  1. Inner layer or lining: The lining (mucosa) of the esophagus is wet, which helps food to pass to the stomach.
  2. Submucosa: Glands in the submucosa layer make mucus, which helps keep the lining of the esophagus wet.
  3. Muscle layer: The muscles push food down to the stomach.
  4. Outer layer: The outer layer covers the esophagus.

Cancer Cells:

Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the esophagus. Normal cells in the esophagus and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

A tumor in the esophagus can be benign (not cancer) or malignant (cancer):

Benign tumors:

  1. Are rarely a threat to life
  2. Don't invade the tissues around them
  3. Don't spread to other parts of the body
  4. Can be removed and don't usually grow back

Malignant tumors (cancer of the esophagus):

  1. May be a threat to life
  2. Can invade and damage nearby organs and tissues
  3. Can spread to other parts of the body
  4. Sometimes can be removed but may grow back

Esophageal cancer cells can spread by breaking away from an esophageal tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.

When esophageal cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if esophageal cancer spreads to the liver, the cancer cells in the liver are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not liver cancer. For that reason, it is treated as cancer of the esophagus, not liver cancer.

Types of Esophageal Cancer

  1. AdenoCarcinoma (AC): Usually, AC tumors are found in the lower part of the esophagus, near the stomach. AC of the esophagus may be related to having acid reflux (the backward flow of stomach acid), having a disease of the lower esophagus known as Barrett esophagus, or being obese.
  2. Squamous Cell Carcinoma (SCC) Usually, SCC tumors are found in the upper part of the esophagus. SCC of the esophagus may be related to being a heavy drinker of alcohol or smoking tobacco.

Tests

After you learn that you have cancer of the esophagus, you may need other tests to help with making decisions about treatment.

Tumor Grade Test

The tumor tissue that was removed during your biopsy procedure can be used in lab tests. The pathologist studies tissue samples under a microscope to learn the grade of the tumor. The grade tells how different the tumor tissue is from normal esophagus tissue.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

For more about tumor grade, see the NCI fact sheet Tumor Grade.

wHAT IS Esophagus CANCER SURGERY?

People with cancer of the esophagus have many treatment options. Treatment options include:

  1. Surgery
  2. Radiation therapy
  3. Chemotherapy
  4. Targeted therapy

You and your doctor will develop a treatment plan. The treatment that's right for you depends mainly on the type and stage of esophageal cancer. You'll probably receive more than one type of treatment. For example, radiation therapy and chemotherapy may be given before or after surgery.

Surgery may be an option for people with early-stage cancer of the esophagus. Usually, the surgeon removes the section of the esophagus with the cancer, a small amount of normal tissue around the cancer, and nearby lymph nodes. Sometimes, part or all of the stomach is also removed.

If only a very small part of the stomach is removed, the surgeon usually reshapes the remaining part of the stomach into a tube and joins the stomach tube to the remaining part of the esophagus in the neck or chest. Or, a piece of large intestine or small intestine may be used to connect the stomach to the remaining part of the esophagus.

If the entire stomach needs to be removed, the surgeon will use a piece of intestine to join the remaining part of the esophagus to the small intestine.

During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal.

You may have pain from the surgery. However, your health care team will give you medicine to help control the pain. Before surgery, you may want to discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain relief.

Your health care team will watch for pneumonia or other infections, breathing problems, bleeding, food leaking into the chest, or other problems that may require treatment.

The time it takes to heal after surgery is different for everyone. Your hospital stay may be a week or longer, and your recovery will continue after you leave the hospital.

Radiation Therapy

Radiation therapy is an option for people with any stage of esophageal cancer. The treatment affects cells only in the area being treated, such as the throat and chest area.

Radiation therapy may be given before, after, or instead of surgery. Chemotherapy is usually given along with radiation therapy.

Radiation therapy for esophageal cancer may be given to...

  1. Destroy the cancer
  2. Help shrink the tumor so that you can swallow more easily
  3. Help relieve pain from cancer that has spread to bone or other tissues

Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive both types:

  1. Machine outside the body: The radiation comes from a large machine. This is called external radiation therapy. The machine aims radiation at your body to kill cancer cells. It doesn't hurt. You'll go to a hospital or clinic, and you'll lie down on a treatment table. Each treatment session usually lasts less than 20 minutes. Treatments are usually given 5 days a week for several weeks.
  2. Radioactive material inside the body (brachytherapy): The doctor numbs your throat with an anesthetic spray and gives you medicine to help you relax. The doctor puts a tube into your esophagus. The radiation comes from the tube. After the tube is removed, no radioactivity is left in your body. Usually, one treatment session is needed. Because the treatment session lasts one to two days, you'll probably stay in a special room at the hospital.

Chemotherapy

Most people with esophageal cancer get chemotherapy. It may be used alone or with radiation therapy.

Chemotherapy uses drugs to kill cancer cells. The drugs for cancer of the esophagus are usually given directly into a vein (intravenously) through a thin needle.

Targeted Therapy

People with esophageal cancer that has spread may receive a type of treatment called targeted therapy. This treatment can block the growth and spread of esophageal cancer cells.

Targeted therapy for cancer of the esophagus is usually given intravenously. The treatment enters the bloodstream and can affect cancer cells all over the body.

During treatment, your health care team will watch you for side effects. You may get diarrhea, belly pain, heartburn, joint pain, tingling arms and legs, or heart problems. Most side effects usually go away after treatment ends.

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Symptoms

The symptoms of esophageal cancer vary with the stage of the disease. Early-stage cancers may be asymptomatic or simulate the symptoms of reflux disease. Heartburn, regurgitation, and indigestion are symptoms of reflux, but cancer may be underlying cause for these symptoms. Usually patients with esophageal cancer present with dysphagia (difficulty in swallowing of solid initially and later on to liquid) and weight loss. These symptoms usually indicate advanced disease.

Choking, coughing, and aspiration from a tracheoesophageal fistula (un-natural communication between food pipe and wind pipe), as well as hoarseness and vocal cord paralysis are ominous signs of advanced disease.

RISK FACTORS

Adeno-carcinoma of Esophagus

Increasing incidence of acid reflux: Intake of caffeine, fats, and acidic and spicy foods all lead to increase in reflux of acid and damages the inner lining (mucosa) of esophagus, called as Barretts esophagus. If this damage is long standing over a time of year, this mucosa turn into cancer.

Squamous Cell carcinoma of Esophagus

  1. Alcohol
  2. Smoking
  3. Plummer-Vinson syndrome, a disease of iron and vitamin deficiency that results in atrophy of the oropharyngeal and esophageal mucosa.
  4. Achalasia cardia
  5. Esophageal diverticula

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

dIAGNOSIS

If you have symptoms that suggest esophagus cancer, your doctor will check to see whether they are due to cancer or to some other cause. Your doctor may refer you to a gastroenterologist, a doctor whose specialty is diagnosing and treating digestive problems.

Your doctor will ask about your personal and family health history. You may have blood or other lab tests. You also may have

  1. Physical exam: Your doctor feels your abdomen for fluid, swelling, or other changes. Your doctor also will check for swollen lymph nodes.
  2. Endoscopy: Your doctor uses a thin, lighted tube (endoscope) to look into your stomach. Your doctor first numbs your throat with an anesthetic spray. You also may receive medicine to help you relax. The tube is passed through your mouth and esophagus to the stomach.
  3. Biopsy: An endoscope has a tool for removing tissue. Your doctor uses the endoscope to remove tissue from the stomach. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

STAGING

Staging tests can show the stage (extent) of esophageal cancer, such as whether cancer cells have spread to other parts of the body.

When cancer of the esophagus spreads, cancer cells are often found in nearby lymph nodes. Esophageal cancer cells can spread from the esophagus to almost any other part of the body, such as the liver, lungs, or bones.

Staging tests may include:

  1. CT scan: Your doctor may order a CT scan of your chest and abdomen. An x-ray machine linked to a computer will take a series of detailed pictures of these areas. You'll receive contrast material by mouth and by injection into a blood vessel in your arm or hand. The contrast material makes abnormal areas easier to see. The pictures can show cancer that has spread to the liver, lungs, bones, or other organs.
  2. PET scan: Your doctor may use a PET scan to find cancer that has spread. You'll receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in the body. Because cancer cells use sugar faster than normal cells, areas with cancer cells look brighter on the pictures. The pictures can show cancer that has spread to the lymph nodes, liver, or other organs.
  3. EUS: An EUS (endoscopic ultrasound) can show how deeply the cancer has invaded the wall of the esophagus. It can also show whether cancer may have spread to nearby lymph nodes. Your doctor will pass a thin, lighted tube (endoscope) through your mouth to your esophagus. A probe at the end of the tube sends out high-energy sound waves. The waves bounce off tissues in your esophagus and nearby organs, and a computer creates a picture from the echoes. During the exam, the doctor may take tissue samples of lymph nodes.

Stages

Doctors describe the stages of esophageal cancer using the Roman numerals I, II, III, and IV. Stage I isearly-stage cancer, and Stage IV is advanced cancer that has spread to other parts of the body, such as the liver.

The stage of cancer of the esophagus depends mainly on:

  1. How deeply the tumor has invaded the wall of the esophagus
  2. The tumor's location (upper, middle, or lower esophagus)
  3. Whether esophageal cancer cells have spread to lymph nodes or other parts of the body

Stages I and II of Adenocarcinoma of the Esophagus

Stage IA

Cancer has grown through the inner layer and invades the wall of the esophagus. The grade is 1 or 2.

Stage IB

Cancer has invaded the wall of the esophagus and is grade 3. Or, cancer has invaded more deeply into the muscle layer of the esophagus, and the grade is 1 or 2.

Stage IIA

Cancer has invaded the muscle layer of the esophagus, and the grade is 3.

Stage IIB

Cancer has invaded the outer layer of the esophagus. Or, cancer has not invaded the outer layer, but cancer cells are also found in one or two nearby lymph nodes.

Stages I and II of Squamous Cell Cancer of the Esophagus

Stage IA

Cancer has grown through the inner layer and invaded the wall of the esophagus. The grade is 1.

Stage IB

Cancer has invaded the wall of the esophagus and is grade 2 or 3. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1.

Stage IIA

Cancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3.

Stage IIB

Cancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3. Or, cancer has not invaded the outer layer, and cancer cells are found in one or two nearby lymph nodes.

Stages III and IV of Esophageal Cancer (Both Types)

Stage IIIA

Stage IIIA is one of the following:

  1. Cancer has not invaded the outer layer, and cancer cells are found in 3 to 6 nearby lymph nodes.
  2. Or, cancer has invaded the outer layer of the esophagus, and cancer cells are also found in 1 or 2 nearby lymph nodes.
  3. Or, cancer extends through the esophageal wall and has invaded nearby tissues, such as thediaphragm or pleura. No cancer cells are found in lymph nodes.

Stage IIIB

Cancer has invaded the outer layer of the esophagus, and cancer cells are found in 3 to 6 nearby lymph nodes.

Stage IIIC

Stage IIIC is one of the following:

  1. Cancer has invaded tissues near the esophagus, and cancer cells are found in up to 6 nearby lymph nodes.
  2. Or, cancer cells are found in 7 or more nearby lymph nodes.
  3. Or, the cancer can't be removed by surgery because the tumor has invaded the trachea or other nearby tissues.

Stage IV

The esophageal cancer has spread to other parts of the body, such as the liver, lungs, or bones.

OVERVIEW OF CANCER SURGERY

Goal of Cancer Surgery

Depending on your cancer type and stage, our goals for treatment are:

1. Cure : This is the most important goal of cancer surgery. In fact as a cancer patient you are also strongly willing to have cure of cancer for forever. For most of the Liver & Gastro-intestinal cancers perhaps surgery is the first step for cure. Radiation &/or Chemotheray may be advised as an additional tool to achieve this goal.

2. Control : If your cancer is at a later stage or if previous treatments have been unsuccessful, we aim to control your cancer by removing as much as safely possible. Once you recover from surgery, radiation or chemotherapy is advised as important tool to control your cancer.

3. Comfort : If you have an advanced stage of cancer or one that hasn't responded to treatments and having symptoms because of tumor i.e pain, jaundice, vomiting, bleeding either in vomitus or in stool, then our multi-specialist team work together to sure you are free of pain and other symptoms.

Role of Surgery for Cancer treatment

Surgery can be done for many reasons for treatment of cancer.

Diagnostic & Staging Surgery

This type of surgery is used to take out a piece of tissue (biopsy) to find out if cancer is present or what type of cancer it is. The diagnosis of cancer is made by looking at the cells under a microscope. Staging surgery is done to find out how much cancer there is and how far it has spread. The physical exam and the results of lab and imaging tests are used to figure out the clinical stage of the cancer. But the surgical stage (also called the pathologic stage) is usually a more exact measure of how far the cancer has spread. Examples of surgical procedures commonly used to stage cancers, like laparoscopy or laparotomy.

Palliative Surgery

This type of surgery is used to treat problems caused by advanced cancer. It is not done to cure the cancer. For example, cancers of intestine may grow large enough to block off (obstruct) the intestine, or tumor is bleeding and unable to control bleed by medical/endoscopic technique. If this happens, surgery can be used to remove the blockage/control bleeding.

How surgery is performed? (Special surgery techniques):

Open Surgery:

It is the Gold Standard approach for Liver & Gastro-Intestinal cancer. An incision is given on the belly depending upton the underlying location of tumor so that surgeon can directly approach the cancer on cutting the belly. Open Surgery help to remove tumor safely if its adherent to near by blood vessels or organ, that is otherwise difficult in laparoscopic surgery.

Laparoscopic Surgery

1. A laparoscope is a long, thin, flexible tube that can be put through a small cut (incision) to look inside the body. In recent years, doctors have found that by creating small holes and using special instruments, the laparoscope can be used to perform surgery without making a large cut. This can help reduce blood loss during surgery and pain afterward. It can also shorten hospital stays and allow people to heal faster.

2. The role of laparoscopic surgery in cancer treatment is not yet clear. Doctors are now studying whether it is safe and effective to use laparoscopic surgeries for cancers of the stomach, colon, rectum & liver. It may prove to be as safe and work as well as standard surgery while cutting less and causing less damage to healthy tissues (being less invasive).

Biopsy of Cancer before Surgery

Biopsy is procedure to confirm the presence of cancer. It’s not essential before surgery. Usually biopsy is performed when 1. Suspicion is cause other than cancer, 2. When surgery cannot be done for cancer due to advanced stage of cancer or 3. Patient is unfit to undergo surgery. In these situation, biopsy guides for further therapy.

If all investigations suggest that cancer can be removed in totality from body, then biopsy can be avoided in to minimize the risk of spillage of cancer cell during biopsy procedure.

There are variety of ways to perform biopsy:

Fine Needle Aspiration (FAN) biopsy

1. Fine needle aspiration (FNA) uses a very thin needle attached to a syringe to pull out small bits of tissue. The needle is guided into the tumor by looking at it using an imaging test, like an ultrasound or CT scan.

2. The main advantage of FNA is that there is no need to cut through the skin, so there is no surgical incision.

3. A drawback is that in some cases the needle can’t take out enough tissue for an exact diagnosis. A more invasive type of biopsy (one that involves larger needles or a cut in the skin) may then be needed.

Core Needle biopsy

This type of biopsy uses a larger needle to take out a core of tissue and done under guidance of imaging test like an ultrasound or CT scan. The advantage of core biopsy is that it usually collects enough tissue to find out whether the tumor is cancer.

Excisional or Incisional biopsy

For these biopsies, the surgeon remove the entire tumor (excisional biopsy) or a small part of the tumor (incisional biopsy)

PREPARATION OF CANCER SURGERY

Our expert team members shall help you to prepare you for surgery. You are strongly advised to stop smoking, stop drinking alcohol, try to improve your diet, lose weight, or actively exercise before surgery.

Pre-operative testing

In most cases, you will need some tests before your surgery. The tests routinely used include:

1. Blood tests to measure your blood counts, your risk of bleeding or infection, and how well your liver and kidneys are working. Your blood group type is also be checked in case you need blood transfusions during the operation.

2. Chest x-ray and ECG (electrocardiogram) to check your lungs and your heart’s electrical system.

3. USG/CT scans/ MRI to look at the size and location of the tumors and see if the cancer looks like it has spread to nearby tissues.

Anaesthetic Assessment before Surgery:

Our expert team of Anaesthetist will ask you questions pertaining to your health and to assess your fitness for surgery. You are requested to tell them in detail about your current and past medical ailments, allergic reactions you’ve had in the past and current medicines that you are taking like blood thinning medicine. This medicine should be stopped 1 week prior to surgery.

Informed Consent

Informed consent is one of the most important parts of “getting ready for surgery”. It is a process during which you are told about all aspects of the treatment before you give your doctor written permission to do the surgery.

Getting ready for Surgery

Depending on the type of operation you have, there may be things you need to do to be ready for surgery:

  1. Emptying your stomach and bowels (digestive tract) is important. Vomiting while under anaesthesia can be very dangerous because the vomit could get into your lungs and cause an infection. Because of this, you will be asked to not eat or drink anything starting the night before the surgery.
  2. Laxative: You may also be asked to use a laxative or an enema to make sure your bowels are empty.
  3. Shaving of Operative part: You need to have an area of your body shaved to keep hair from getting into the surgical cut (incision). The area will be cleaned before the operation to reduce the risk of infection.

ANAESTHESIA

Anaesthesia is the use of drugs to make the body unable to feel pain for a period of time. General anaesthesia puts you into a deep sleep for the surgery. It is often started by having you breathe into a face mask or by putting a drug into a vein in your arm. Once you are asleep, an endotracheal or ET tube is put in your throat to make it easy for you to breathe. Your heart rate, breathing rate, and blood pressure (vital signs) will be closely watched during the surgery. A doctor watches you throughout the procedure and until you wake up. They also take out the ET tube when the operation is over. You will be taken to the recovery room to be watched closely while the effects of the drugs wear off. This may take hours. People waking up from general anaesthesia often feel "out of it" for some time. Things may seem hazy or dream-like for a while. Your throat may be sore for a while from the endotracheal (ET) tube.

Risks & Side-Effects of Surgery

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. What’s important is whether the expected benefits outweigh the possible risks.

Doctors have been performing surgeries for a very long time. Advances in surgical techniques and our understanding of how to prevent infections have made modern surgery safer and less likely to damage healthy tissues than it has ever been. Still, there’s always a degree of risk involved, no matter how small. Different procedures have different kinds of risks and side effects. Be sure to discuss the details of your case with our health care team, who can give you a better idea about what your actual risks are. During surgery, possible complications during surgery may be caused by the surgery itself, the drugs used (anesthesia), or an underlying disease. Generally speaking, the more complex the surgery is the greater the risk. Complications in major surgical procedures include:

1. Complications related to Anaesthesia : Reactions to drugs used (anesthesia) or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures. Your doctors will watch your heart rate, breathing rate, blood pressure, and other signs throughout the procedure to look for this.

2. Complications related to underlying medical illness like heart disease, diabetes, kidney disease, obesity, malnutrition.

Lung : Pneumonia, Atelectasis (collapse of lung), effusion (fluid in chest) can occur, especially in patients with reduced lung function, such as smokers. Doing deep breathing exercises as soon as possible after surgery helps lessen this risk.

Thrombosis (blood clot) in leg & embolism (blood clot) in lung : Blood clots can form in the deep veins of the legs after surgery, especially if a person stays in bed for a long time. Such a clot can become a serious problem if it breaks loose and travels to another part of the body, such as a lung. This is a big reason why you will be encouraged to get out of bed to sit, stand, and walk as soon as possible.

Cardiovascular : Myocardial infarction (heart attach), Arrhythmia (irregular heart beat), Stroke (cerebro-vascular accidents).

Kidney & urinary tract infection, acute kidney failure if patient has uncontrolled/non-responding infection.

3. Complications related to Specific Operations

1. There are specific complications related to type of surgery. You are encouraged with discuss in detail with our health care team before you give your consent for surgery.

2. Bile leak

3. Bleed

4. Complications related to Major Surgery

Infection : Infection at the site of the wound, lung and urinary infection. Infection risk is more if intestine is perforated before surgery, operated for colon and rectum, stent in placed in bile duct to relieve jaundice or intestinal joint is leaking.

Bleeding : The risk of bleeding during or after surgery is more if patient taking blood thinning medicine till day of surgery or having liver dysfunction. Bleeding during surgery that may cause you to need blood transfusions. There is a risk of certain problems with transfusions, some of them serious. Still, some operations involve a certain amount of controlled blood loss. Bleeding can happen either inside the body (internally) or outside the body (externally). It can occur if a blood vessel sealed during surgery opens up or if a wound opens up. Serious bleeding may cause the person to need another operation to find the source of the bleeding and stop it.

Leakage from anastomosis (joint of anastomosis) & fluid collection in tummy.

Blockage of intestine (Intestinal obstruction)

RECOVERY FROM SURGERY

Your recovery right after surgery depends on many factors, including your state of health before the operation and how extensive the operation was performed.

Pain

You may feel pain at the site of surgery. We aim to keep you pain free after surgery with the help of latest and most effective technique or analgesic (pain relieving medicine).

Tube/ Drains

  1. You may also have Ryle’s Tube (tube going through nose to stomach) that drain out intestinal fluid. This tube helps to relieve nausea and vomiting after surgery and usually removed 1-2 day after surgery.
  2. You may also have “Tube” (called a Foley catheter) draining urine from your bladder into a bag. This will be taken out soon after surgery, once you are comfortable enough to go to bathroom.
  3. You may have a tube or tubes (called Drains) coming out of the surgical opening in your skin (incision site). Drains allow the excess fluid that collects at the surgery site to leave the body. Drain tube will also be removed once they stop collecting fluid, usually a few days after the operation.

Leg Stocking / Compression boot

As you are remains in bed on day of surgery, circulation of blood in leg become sluggish that may increase possibility of thrombo-embolism. To minimise it, you will be wearing leg stocking/ pneumatic compression boot to improve your leg circulation thus minimising the risk of thrombolism.

Eating and Drinking

You may not feel much like eating or drinking, but this is an important part of the recovery process. Our health care team may start you out with ice chips or clear liquids. The stomach and intestines (digestive tract) is one of the last parts of the body to recover from the drugs used during surgery. You will need to have signs of stomach and bowel activity before you will be allowed to eat. You will likely be on a clear liquid diet until this happens. Once it does, you may get to try solid foods.

Activity

  1. Our health care team will try to have you move around as soon as possible after surgery. They may even have you out of bed and walking the same day. While this may be hard at first, it helps speed your recovery by getting your digestive tract moving. It also helps your circulation and helps prevent blood clots from forming in your legs.
  2. Our team shall also encourage you to do deep breathing exercises. This helps fully inflate your lungs and reduces the risk of pneumonia. You are advised to take deep breaths and cough every hour to help prevent lung infections. You will use an incentive spirometer (a small device used in breathing exercises to prevent complications after major surgery) 10-15 times every hour.

Going home

Once you are eating and walking, all tube/drains placed during surgery are removed, and then you may be ready to go home. Before leaving for home our health care team shall give you detailed guidance regarding diet, activities, medications & further plan of treatment.

LIFE AFTER SURGERY

Nutrition

  1. Following treatment, you may feel change in your taste. This improves over a time and we encourage having health food habit like fresh vegetables, fruits and high protein diet.

Exercise

  1. Along with healthy food habits, we also encourage for exercise. Exercise improves your health in different ways: It improves your heart and circulation, makes your muscles stronger & makes you feel happier. You should do your regular activities like walking, and rather increase day by day. Weight lifting and strenuous exercise are avoided for initial 2-3 months.

Follow up care

  1. You'll need regular check-ups after treatment for liver cancer. This help to find out any change in your recovery. Sometimes liver cancer comes back after treatment. Our health care team will check for return of cancer. Checkups may include a physical exam, blood tests, ultrasound / CT scan.
  2. If you have any health problems between checkups, you should contact our health care team. Report to our health care team, if you have any redness/ swelling or discharge of any type of fluid from your operative incision site, pain abdomen, vomiting or fever, breathing difficulty etc.

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Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

There are many reasons why some people have difficulty avoiding obesity. Usually, obesity results from a combination of inherited factors, combined with the environment and personal diet and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss procedures are additional options for treating obesity.

Causes

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat.

When most of the diets are too high in calories & often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Symptoms

Obesity is diagnosed when your body mass index (BMI) is 30 or higher. To determine your body mass index, divide your weight in pounds by your height in inches squared and multiply by 703. Or divide your weight in kilograms by your height in meters squared.

BMI Weight status
Below 18.5 Underweight
18.5-24.9 Normal
25.0-29.9 Overweight
30.0 and higher Obesity

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

Risks

Obesity usually results from a combination of causes and contributing factors:

  • Family inheritance and influences
  • Lifestyle choices
  • Certain diseases and medications
  • Social and economic issues
  • Age
  • Other factors (Pregnancy, Quitting smoking, Lack of sleep, Stress, Microbiome, Previous attempts to lose weight etc)

Even if you have one or more of these risk factors, it doesn't mean that you're destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

Prevention

Whether you're at risk of obesity, currently overweight or at a healthy weight, you can take steps to prevent unhealthy weight gain and related health problems. Not surprisingly, the steps to prevent weight gain are the same as the steps to lose weight: daily exercise, a healthy diet, and a long-term commitment to watch what you eat and drink.

  • Exercise regularly.
  • Follow a healthy-eating plan
  • Know and avoid the food traps that cause you to eat.
  • Monitor your weight regularly
  • Be consistent

When to see a doctor

If you're concerned about weight-related health problems, you have come at the right place Request a Callback to discuss about obesity management. We can evaluate your health risks and discuss your weight-loss options.

How we can HELP

Obesity Doctor is one of the most renowned & awarded Obesity/Weight Loss Clinic in India.

Obesity Clinic is a Super Speciality Surgery Center specializing in Bariatric Surgery procedures. We specialize in laparoscopic (key-hole surgery) surgery, Single incision or Scar-less surgery. These techniques are much kinder to the patients as compared to open surgery. Laparoscopy leads to less pain, early recovery and faster return to work.

  • Super Specialist

    in Gastro Intestinal & Laproscopic Surgery
  • 5000+

    surgeries performed successfully
  • Awards & Accolades

    Recipient from various National & International Medical Associations
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  • Roux-en Y Gastric Bypass Surgery

  • Gastric Balloon Surgery

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  • Single Incision Sleeve Gastrectomy

  • Adjustable Gastric Banding Surgery

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  • Duodenal Switch (DS) & Duodeno-Jejunostomy (DJB)

  • Revisional Bariatric Surgery

Why Surgery ?

Benefits of Bariatric Surgery and Why you sould choose it.

Bariatric/weight loss surgery is the only valid treatment option that leads to sustained weight loss in patients suffering from clinically severe obesity. Most people who suffer from obesity have usually tried all methods to lose weight without success before they consider surgery.

Bariatric surgery is recommended for people who are suffering from morbid obesity (if they are more than 30 to 35 kg above their ideal body weight). Bariatric surgery is also a very good treatment option for obese people who suffer from type 2 diabetes mellitus. Surgery leads to significant improvement in diseases associated with obesity such as- diabetes, high blood pressure, dyslipidemia, knee joint pains, PCOD, obstructive sleep apnoea, fatty liver disease, infertility and so on.

Bariatric surgery is the only way people can lose massive amount of weight. It is also easier to maintain the weight loss after surgery than after any other method of losing weight. Surgery also leads to a significant improvement in the quality of life of these patients.

On a daily basis, we see patients who put in their heart and soul into their efforts to lose weight. They have been to every weight loss clinic, celebrity dieticians, gyms, yoga gurus and weight loss retreats. Unfortunately, more often than not, they meet with disappointment and tend to yo-yo between weight loss and weight gain. This entire process is extremely disheartening and demotivating for the patients.

So, if you have tried hard to lose weight without success and the weight is bearing you down, you have come to the right place because bariatric surgery is the only way at the moment that can lead to sustained weight loss in patients suffering from morbid obesity.

Frequently Asked Questions

  1. How much weight can I lose after bariatric surgery and how much time does it take?

    Bariatric surgery leads to about 65 to 75% excess weight loss. Excess weight is calculated as actual weight minus ideal body weight. It takes about 12 to 18 months to lose this weight. Weight loss is very quick in the first 6 months and then it tends to slow down.

  2. Obesity is a chronic progressive disease. Diet and lifestyle modification are an integral part of management of obesity. Patients who embrace the diet and lifestyle modification after surgery tend to get better results. Some degree of weight regain is expected in the long term but it can be controlled if the patient is following a healthy lifestyle.

  3. After bariatric surgery, patients need to be on a liquid diet for about 15 days. This is followed by a phase of semi-solid or soft diet for another 15 days. After a month, most patients are able to have normal food, albeit in limited quantity. Initially the intake is very low but over a period of time, patients are able to eat better. It is also advised to have nutritional supplements in the form of protein supplement, iron, calcium and multivitamins. These will be advised by your doctor based upon your reports as well as the type of surgery.

  4. The cost of bariatric surgery depends on the type of surgery and the room category that you choose. At the moment insurance companies do not cover it routinely but evaluate on case to case basis. There is also an option of medical loan through which patients can get the facility of paying for the surgery in monthly EMIs.

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  • Roux-en Y Gastric Bypass Surgery

  • Gastric Balloon Surgery

  • Gastric Sleeve Surgery OR Sleeve Gastrectomy

  • Single Incision Sleeve Gastrectomy

  • Adjustable Gastric Banding Surgery

  • c

  • Duodenal Switch (DS) & Duodeno-Jejunostomy (DJB)

  • Revisional Bariatric Surgery

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Obesity is one of the biggest health problems in the world.

It’s associated with several related conditions, collectively known as metabolic syndrome. These include high blood pressure, elevated blood sugar and a poor blood lipid profile.

People with metabolic syndrome are at a much higher risk of heart disease and type 2 diabetes, compared to those whose weight is in a normal range.

Over the past decades, much research has focused on the causes of obesity and how it could be prevented or treated.

Many people seem to think that weight gain and obesity are caused by a lack of willpower.

That’s not entirely true. Although weight gain is largely a result of eating behavior and lifestyle, some people are at a disadvantage when it comes to controlling their eating habits.

The thing is, overeating is driven by various biological factors like genetics and hormones. Certain people are simply predisposed to gaining weight ( 1 Trusted Source ).

Of course, people can overcome their genetic disadvantages by changing their lifestyle and behavior. Lifestyle changes require willpower, dedication and perseverance.

Nevertheless, claims that behavior is purely a function of willpower is far too simplistic.

They don’t take into account all the other factors that ultimately determine what people do and when they do it.

Here are 10 factors that are leading causes of weight gain, obesity and metabolic disease, many of which have nothing to do with willpower.

Obesity has a strong genetic component. Children of obese parents are much more likely to become obese than children of lean parents.

That doesn’t mean that obesity is completely predetermined. What you eat can have a major effect on which genes are expressed and which are not.

Non-industrialized societies rapidly become obese when they start eating a typical Western diet. Their genes didn’t change, but the environment and the signals they sent to their genes did.

Put simply, genetic components do affect your susceptibility to gaining weight. Studies on identical twins demonstrate this very well ( 2 Trusted Source ).

Summary Some people appear to be genetically susceptible to weight gain and obesity.

Heavily processed foods are often little more than refined ingredients mixed with additives.

These products are designed to be cheap, last long on the shelf and taste so incredibly good that they are hard to resist.

By making foods as tasty as possible, food manufacturers are trying to increase sales. But they also promote overeating.

Most processed foods today don’t resemble whole foods at all. These are highly engineered products, designed to get people hooked.

Summary Stores are filled with processed foods that are hard to resist. These products also promote overeating.

Many sugar-sweetened, high-fat junk foods stimulate the reward centers in your brain ( 3, 4 Trusted Source ).

In fact, these foods are often compared to commonly abused drugs like alcohol, cocaine, nicotine and cannabis.

Junk foods can cause addiction in susceptible individuals. These people lose control over their eating behavior, similar to people struggling with alcohol addiction losing control over their drinking behavior.

Addiction is a complex issue that can be very difficult to overcome. When you become addicted to something, you lose your freedom of choice and the biochemistry in your brain starts calling the shots for you.

Summary Some people experience strong food cravings or addiction. This especially applies to sugar-sweetened, high-fat junk foods which stimulate the reward centers in the brain.

Junk food producers are very aggressive marketers.

Their tactics can get unethical at times and they sometimes try to market very unhealthy products as healthy foods.

These companies also make misleading claims. What’s worse, they target their marketing specifically towards children.

In today’s world, children are becoming obese, diabetic and addicted to junk foods long before they’re old enough to make informed decisions about these things.

Summary Food producers spend a lot of money marketing junk food, sometimes specifically targeting children, who don’t have the knowledge and experience to realize they are being misled.

Insulin is a very important hormone that regulates energy storage, among other things.

One of its functions is to tell fat cells to store fat and to hold on to the fat they already carry.

The Western diet promotes insulin resistance in many overweight and obese individuals. This elevates insulin levels all over the body, causing energy to get stored in fat cells instead of being available for use ( 5 Trusted Source ).

While insulin’s role in obesity is controversial, several studies suggest that high insulin levels have a causal role in the development of obesity ( 6 Trusted Source ).

One of the best ways to lower your insulin is to cut back on simple or refined carbohydrates while increasing fiber intake ( 7 Trusted Source ).

This usually leads to an automatic reduction in calorie intake and effortless weight loss — no calorie counting or portion control needed ( 8 Trusted Source , 9 Trusted Source ).

Summary High insulin levels and insulin resistance are linked to the development of obesity. To lower insulin levels, reduce your intake of refined carbs and eat more fiber.

Many pharmaceutical drugs can cause weight gain as a side effect ( 10 Trusted Source ).

For example, antidepressants have been linked to modest weight gain over time ( 11 Trusted Source ).

Other examples include diabetes medication and antipsychotics ( 12 Trusted Source , 13 Trusted Source ).

These drugs don’t decrease your willpower. They alter the function of your body and brain, reducing metabolic rate or increasing appetite ( 14 Trusted Source , 15 Trusted Source ).

Summary Some medications may promote weight gain by reducing the number of calories burned or increasing appetite.

Leptin is another hormone that plays an important role in obesity.

It is produced by fat cells and its blood levels increase with higher fat mass. For this reason, leptin levels are especially high in people with obesity.

In healthy people, high leptin levels are linked to reduced appetite. When working properly, it should tell your brain how high your fat stores are.

The problem is that leptin isn’t working as it should in many obese people, because for some reason it cannot cross the blood-brain barrier ( 16 Trusted Source ).

This condition is called leptin resistance and is believed to be a leading factor in the pathogenesis of obesity.

Summary Leptin, an appetite-reducing hormone, doesn’t work in many obese individuals.

Another factor that dramatically influences people’s waistline is food availability, which has increased massively in the past few centuries.

Food, especially junk food, is everywhere now. Shops display tempting foods where they are most likely to gain your attention.

Another problem is that junk food is often cheaper than healthy, whole foods, especially in America.

Some people, especially in poorer neighborhoods, don’t even have the option of purchasing real foods, like fresh fruit and vegetables.

Convenience stores in these areas only sell sodas, candy and processed, packaged junk foods.

How can it be a matter of choice if there is none?

Summary In some areas, finding fresh, whole foods may be difficult or expensive, leaving people no choice but to buy unhealthy junk foods.

Added sugar may be the single worst aspect of the modern diet.

That’s because sugar changes the hormones and biochemistry of your body when consumed in excess. This, in turn, contributes to weight gain.

Added sugar is half glucose, half fructose. People get glucose from a variety of foods, including starches, but the majority of fructose comes from added sugar.

Excess fructose intake may cause insulin resistance and elevated insulin levels. It also doesn’t promote satiety in the same way glucose does ( 17 Trusted Source , 18 Trusted Source , 19 Trusted Source ).

For all these reasons, sugar contributes to increased energy storage and, ultimately, obesity.

Summary Scientists believe that excessive sugar intake may be one of the main causes of obesity.

People all over the world are being misinformed about health and nutrition.

There are many reasons for this, but the problem largely depends on where people get their information from.

Many websites, for example, spread inaccurate or even incorrect information about health and nutrition.

Some news outlets also oversimplify or misinterpret the results of scientific studies and the results are frequently taken out of context.

Other information may simply be outdated or based on theories that have never been fully proven.

Food companies also play a role. Some promote products, such as weight loss supplements, that do not work.

Weight loss strategies based on false information can hold back your progress. It’s important to choose your sources well.

Summary Misinformation may contribute to weight gain in some people. It can also make weight loss more difficult.

If you have concerns about your waistline, you should not use this article as an excuse to give up.

While you can’t fully control the way your body works, you can learn how to control your eating habits and change your lifestyle.

Unless there is some medical condition getting in your way, it is within your power to control your weight.

It often takes hard work and a drastic lifestyle change, but many people do succeed in the long run despite having the odds stacked against them.

The point of this article is to open people’s minds to the fact that something other than individual responsibility plays a role in the obesity epidemic.

The fact is that modern eating habits and food culture must be changed to be able to reverse this problem on a global scale.

The idea that it is all caused by a lack of willpower is exactly what food producers want you to believe, so they can continue their marketing in peace.

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