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Last updated: 19-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
In short
A transhiatal operation removes the food pipe through two cuts, one on the upper belly and one in the left neck. The chest is not opened.
The route is chosen for the patient, not for the tumour. Poor lung reserve is the usual reason. The tumour must sit low in the food pipe.
The chest nodes are not cleared on this route. A Dutch trial found overall survival similar to the chest operation, with fewer lung problems.
This page covers one route. Staging, treatment before surgery and the choice between all the routes are on the main robotic food pipe cancer surgery in Ahmedabad page.
A cancer operation takes out the diseased food pipe and the nodes around it. Most routes reach the chest part through a cut between the ribs. This one does not.
The surgeon works through the natural gap in the diaphragm, called the hiatus. A hand is passed up through it and the chest part is freed by feel. A cut in the left neck frees the top. The two hands meet behind the breastbone.
| Cut | What is done through it |
|---|---|
| Upper belly | The stomach is shaped into a tube. The belly nodes come out. The diaphragm gap is widened. |
| Left neck | The top of the food pipe is freed, and the join is made here. |
| No chest cut | The chest part is freed by feel, from below and from the neck. |
The route is chosen for the patient first. The limit is usually the lungs, not the cancer. Severe lung disease, a breathing test around 1.5 litres or below, past surgery or radiation on the right chest, age above 80 with limited reserve, and dense scarring after chemoradiation are the usual reasons.
The tumour then has to suit it. It should sit in the lower third of the food pipe, or at the junction on the food pipe side. Early tumours are the most suitable, because few nodes are involved.
A tumour in the middle or upper food pipe is not treated this way. That part lies against the windpipe and cannot be freed safely by feel. The route is also set aside when the tumour has grown into the heart lining, the lung lining or the diaphragm, or when bulky nodes sit beside the windpipe.
| Route | Join | Usually chosen when |
|---|---|---|
| Transhiatal, belly and neck | Left neck. | The lungs cannot take a chest operation and the tumour sits low. Chest nodes are not cleared. |
| Belly and right chest, the Ivor Lewis route | Inside the chest. | A lower-third or junction tumour, with workable lungs. Chest nodes come out. |
| Three cuts with a neck join, the McKeown route | Left neck. | A tumour higher up in the chest. Belly, chest and neck nodes come out. |
A chest operation is the better choice when the lungs allow one. Poor lung reserve, not convenience, makes this route the right answer.
A Dutch trial compared this route with a wide chest operation for lower food pipe tumours. Fewer lung problems followed this route, and overall survival came out similar.
The stomach is the replacement. Its blood supply is protected with care, because the join depends on it.
The nerve to the voice box runs in the groove beside the windpipe, right next to the food pipe on the left. It is found and kept. If it is bruised the voice turns hoarse and swallowing is less safe for some weeks. Most voices recover.
The join is usually made with a stapler, side to side, which lowers the chance of a leak and of narrowing. A soft drain is left in the neck, and no chest tube is normally needed. If the chest lining is entered by accident, one is placed before you leave theatre.
This needs saying plainly. The transhiatal operation was described as an open operation, and most are still done that way. The belly part can be done with keyhole or robotic help, and a few centres do the whole operation robotically. Neither is standard yet.
The reason is the route itself. Here the chest part is freed by feel, not under a camera, so the robot changes less than on a route that works inside the chest.
| Part of the operation | What the robot adds |
|---|---|
| Freeing the stomach and clearing the belly nodes. | A steady magnified view and wristed tools. Done robotically where it is offered. |
| Freeing the chest part, the neck cut and the join. | Little or nothing. All three are done by hand, by feel. |
| Chest work on the other two routes. | A great deal. That is where the robot earns its place here. |
Keyhole and robotic chest operations have themselves cut lung problems a long way, so the old advantage of avoiding the chest has narrowed. The route still stands where the chest cannot be entered at all.
If the food pipe cannot be freed safely by feel, the chest is opened and the operation goes on from there. That is a planned safety step, not a failure.
Freeing the chest part by hand presses on the heart, so blood pressure can dip during it. The anaesthetist is told before that part begins. Afterwards you sit up and walk on the first day, and chest physiotherapy starts at once. Tube feeding begins early. The neck drain comes out after a few days, and sips of water start when the team is satisfied. Most people go home at about two weeks, on small frequent meals.
Your own figures are discussed at the consent meeting.
Because the lungs may not take it. During a chest operation one lung is rested, and in severe lung disease that is risky.
Yes. The lower food pipe and belly nodes come out, but the chest nodes are not cleared. A Dutch trial found survival similar, with fewer lung problems.
Mostly it is done open. The belly part can be robotic. The chest part is freed by feel, so the robot adds little there.
No. A tumour in the middle or upper food pipe lies against the windpipe and cannot be freed safely by feel. A chest route is used instead.
Food pipe cancer surgery here is covered on the robotic food pipe cancer surgery page. The chest route is on the robotic Ivor Lewis page. Before you travel, call +91-63590-11009.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and biopsy reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Told your lungs may not take a chest operation for food pipe cancer? The CT, PET, endoscopy report and breathing test can be sent ahead on WhatsApp. The route is decided at the consultation, after examination. Call +91-63590-11009 Send your reports before the visit
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