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A cancer in the middle of the food pipe lies behind the windpipe. The operation works in the chest, the abdomen and the neck. This page explains what the robot changes in the parts it does, and why the join goes in the neck. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 12-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Robotic Cancer Surgeon (GI)
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
★★★★★ Google: 4.9 from 53 reviews (Gota clinic) · 5.0 from 25 reviews (Apollo, Bhat)
Shah’s Gastro, Cancer & Robotic Surgery Centre. Two higher degrees in GI surgery and 18 years of experience in GI and cancer surgery. Every food pipe cancer goes to the tumour board before treatment. Dr Harsh Shah performs the operation himself.
In short
A cancer in the middle of the food pipe lies behind the windpipe, at the level of the azygos vein. A safe cut above it needs a join in the neck.
Our protocol uses a McKeown operation for it. Work is done in the chest, the abdomen and the neck. The robot does the chest and abdomen parts.
The robot helps most in the chest. Its 3D view and wristed tools work close to the airway and the voice nerves. The neck part is always a small open cut.
The middle third sits in the chest, right behind the windpipe and its left branch. The azygos vein arches over it. These neighbours shape every robotic step.
A lower-third tumour is close to the stomach. There is room to cut above it and still join inside the chest. A middle-third tumour is higher. A cut that is safely clear of it usually lands above the azygos arch.
A join above that arch is hard to make inside the chest. So for a mid-third tumour, our protocol brings the stomach tube up to the neck and makes the join there. This is the McKeown, or three-stage, operation.
| Feature | Middle third | Lower third, for comparison |
|---|---|---|
| Main neighbours. | The windpipe, its left branch and the azygos vein. | The aorta, the heart sac and the diaphragm. |
| Usual operation. | McKeown, three stages. | Ivor Lewis, two stages. |
| Where the join is made. | In the neck. | In the chest. |
| Number of areas worked on. | Three: chest, abdomen and neck. | Two: abdomen and chest. |
| Main robotic gain. | Work near the airway and the voice nerves. | Work beside the aorta and the chest join. |
A tumour low in the food pipe has its own page: robotic oesophagectomy, chest and abdomen phases.
Before any plan, the airway is checked with a thin camera for a squamous cancer at this level. Most patients then get treatment before the operation.
The camera test looks for cancer growing into the windpipe. If the cancer has grown into the airway, it cannot be removed safely. Chemoradiation is then the main treatment, not surgery.
| Cell type | Treatment before surgery | When the operation follows |
|---|---|---|
| Squamous cell cancer. | Chemotherapy and radiation together, over about five weeks. | Six to eight weeks after it ends. |
| Adenocarcinoma. | Four cycles of a four-drug chemotherapy plan, given every two weeks. | Four to six weeks after the last cycle. Four more cycles follow surgery. |
The tests in order and the full treatment plan are on the middle food pipe cancer pathway. This page covers the robotic operation itself.
The operation works in three areas. The robot is used in two of them. The neck part is always done open, through one short cut.
| Area | What is done there | How it is done |
|---|---|---|
| Right chest. | The whole chest part of the food pipe is freed with its lymph nodes. The azygos vein is divided. | Robotic. |
| Abdomen. | The stomach is freed and shaped into a tube. Nodes around the stomach vessels are removed. A feeding tube is often placed. | Robotic. |
| Neck, left side. | The food pipe is cut in the neck. The stomach tube is brought up and joined to it. | Open, through a short cut. |
Our surgical protocol sets which areas are worked on and where the join goes. Your surgeon explains the plan for your own operation at the consent visit.
The chest part is where the robot changes most. Its steady 3D view and wristed tools let the surgeon free the food pipe off the windpipe in a narrow space.
For this part you lie partly face-down or on your side. The right lung is rested while the left lung breathes for both. A robotic arm can hold the lung gently aside.
Four robotic ports go between the ribs on the right side. One assistant port sits in front of them. Through these, the surgeon reaches from the top of the chest down to the diaphragm.
The azygos vein arches over the food pipe at this level. It is sealed and divided so the tumour can be lifted clear. The surgeon then works along the back of the windpipe and its left branch.
This is a thin plane. Straight keyhole tools reach it at a fixed angle. Wristed tools can turn and follow the curve of the airway. The magnified view shows small vessels and nerves before they are touched.
If the tumour is stuck to the airway or the azygos and the plane is unclear, the plan changes. The surgeon may convert to open surgery. That is a safety decision.
Two thin nerves run beside the food pipe in the upper chest and control the voice box. The robot’s view helps the surgeon see and protect them.
These are called the recurrent laryngeal nerves. Lymph nodes sit along them, and some are removed with the chest nodes. Working close to a nerve without pulling on it is a key skill.
The robot’s 3D view and fine wristed movement help with this dissection. Even so, a hoarse voice can follow. It is usually temporary.
Voice change is one of the risks your surgeon discusses with you in person before consent. If it happens, a voice and swallow assessment follows. Thicker fluids are used for a while to make swallowing safe.
Nodes in the chest and upper abdomen are removed as standard. Neck nodes are added only for selected squamous cancers with nodes high in the chest or neck.
| Field | When it is cleared | Which part of the operation |
|---|---|---|
| Chest, along the food pipe and the airway. | Always. | Robotic chest part. |
| Upper abdomen, around the stomach vessels. | Always. | Robotic abdominal part. |
| Lower neck. | Selectively, for squamous cancer with nodes high in the chest or neck. | Open neck part. |
Our protocol sets a minimum number of nodes for the pathologist to examine. The robot removes the same nodes as open surgery. Along the airway, its wristed tools are a real help.
For the abdominal part you lie on your back, and the robot is docked over the abdomen. The stomach is shaped into a long tube that will reach the neck.
Four robotic ports and one assistant port go across the upper abdomen. A robotic arm can hold the liver up. This gives a clear view of the top of the stomach.
The stomach’s main blood supply, along its greater curve, is kept with great care. The vessels on its upper side are tied at their root, with their nodes. The stomach is then cut into a narrow tube with staplers.
For a neck join, the tube must be long and have a good blood supply right to its tip. A dye given into a vein glows under the robot’s camera. It shows whether the tip has good blood flow before the tube is moved.
The join is made through a short cut on the left side of the neck. This part is not robotic. A leak here is easier to drain than one in the chest.
The surgeon finds the food pipe in the neck and cuts it well above the tumour. The stomach tube is brought up to meet it. The two are joined by stitches or staples.
Why accept a neck cut? First, it allows a clear margin above a mid-third tumour. Second, if the join leaks, the neck wound can be opened at the bedside to drain it.
The neck join has a known downside. It narrows more often than a chest join. A simple stretch through an endoscope usually fixes it, and it may need repeating.
All three approaches remove the same tissue and nodes. They differ in the cuts, blood loss, the view near the airway, chest infections, the hospital stay and return to work.
| Open | Keyhole | Robotic | |
|---|---|---|---|
| Cuts. | A long chest cut, an abdominal cut and a neck cut. | Small ports, and a neck cut. | Small ports, and a neck cut. |
| Blood loss. | More. | Less. | Less. |
| View near the airway. | Direct, but deep. | Magnified, flat. | Magnified, 3D, steady. |
| Work near the voice nerves. | By hand. | Straight tools. | Wristed tools. |
| Nodes cleared. | The same. | The same. | The same. |
| Chest infections. | More. | Fewer. | Fewer. |
| Hospital stay. | Longest. | Shorter. | Shorter. |
| Return to work. | Later. | Sooner. | Sooner. |
| Cost. | Lowest. | Close to open. | Higher, for the robotic tools. |
Our protocol prefers keyhole or robotic surgery where the team has the experience. The figures for your own operation are given at the consent visit.
Some mid-third cancers need open surgery, and some need no operation at all. The airway, past treatment and your lungs decide this.
| Situation | Usual plan |
|---|---|
| Cancer grown into the windpipe or the aorta. | No operation. Chemoradiation is the main treatment. |
| Cancer that comes back after chemoradiation alone. | An operation is considered by the tumour board. It is often open, because of scarring. |
| A past right chest operation with the lung stuck down. | Open surgery is considered. |
| Very weak lungs on breathing tests. | Breathing training first. Open or another plan is considered. |
| Tumour stuck to the airway or the azygos vein during surgery. | Change to open if the plane is unclear. |
| Too unwell for a major operation. | Chemoradiation, or a gentler plan. |
You sit out of bed on the evening of surgery. Feeds start through a small tube the next day. A swallow test may come before the first sips.
| When | What happens |
|---|---|
| Day of surgery. | Breathing tube out early. Head raised. Sitting out of bed. Breathing exercises. |
| Next day. | Walking two or three times. Slow feeds through the tube. Chest physiotherapy. |
| Second and third days. | Feeds increased. Walking four times. Drip reduced. Stomach tube out when drainage is low. |
| Fourth and fifth days. | A water trial. A dye swallow X-ray first if there is any worry about the neck join. |
| Sixth to eighth days. | Soft diet. Chest drain out. Discharge checks. |
The team acts the same day on warning signs. Redness or swelling of the neck wound, fever, a fast pulse or a new irregular heartbeat may mean a leak. A hoarse voice with coughing on drinking is also checked at once.
Most people go home eating soft food or on tube feeds. Voice and swallowing are watched at each visit. Work returns in stages, led by your eating.
Before discharge, a family member learns to care for the feeding tube. A dietitian writes your meal plan. Eat five or six small meals a day, and sleep with the head raised.
If your voice was hoarse, it is checked again at each visit. If food sticks in the neck weeks later, the join is stretched through an endoscope.
Desk work usually comes back before heavy work. Lifting waits until the chest, abdomen and neck have healed. Your own return date is set at the follow-up visits.
Food can rush through quickly at first. This can cause weakness or dizziness after meals. Smaller meals with less sugar help.
The tissue report is discussed at two weeks. It decides whether you need immunotherapy, more chemotherapy, or careful watching. Visits continue for ten years.
| Situation or time | What follows |
|---|---|
| Cancer left in the specimen after chemoradiation. | Immunotherapy for one year, starting within four to sixteen weeks. |
| No cancer left after chemoradiation. | No further drugs. Follow-up only. |
| Adenocarcinoma after the four-drug plan. | The four cycles after surgery are completed. |
| Every three months for ten years. | Symptoms, weight, swallowing, voice and fitness. |
| Scans. | CT of chest and abdomen every six months for two years. Then yearly to five years. |
★★★★★
“Excellent doctor for stomach cancer. We r very happy. Recommend for gastro cancer treatment in Ahmedabad”
Purshottam Meena · Google review
★★★★★
“I had a truly positive experience with Dr. Harsh Shah. He is not only highly knowledgeable but also very compassionate and patient in explaining every detail. I underwent CRS HIPEC surgery under his care, and I couldn’t have asked for a better doctor. The entire process was smooth, and his expertise made a complex procedure feel manageable. Post-surgery recovery was well-monitored, and he was always available for any concerns. Highly recommend Dr. Harsh Shah for anyone needing advanced surgical oncology care.”
Akram Khan · Google review
★★★★★
“Dr harsh operated my sister for liver cancer .we came for follow up .Now she is good. Thank u so much sir”
Natu Vadalia · Google review
Quoted exactly as written on the centre’s Google listings: a stomach cancer patient’s family, and two patients of Dr Harsh Shah treated for other cancers. No review on these listings yet names the food pipe. Below them, a patient speaks after robotic surgery for food pipe cancer.
Watch Dr Harsh Shah’s step-by-step video of a robotic oesophagectomy for food pipe cancer (YouTube).
A robotic McKeown costs more than an open one, because of the robotic tools. A longer stay, neck stretching later or a complication changes the total.
The office prepares a written estimate once the operation is decided. Cashless admission is arranged at Apollo Hospital, Bhat when your policy allows it. Allow a day or two for robotic approval. Ask whether your policy covers robotic surgery, and up to what limit. Bring the policy papers, photo identity, all reports with scans on disc, and your medicine list.
A safe cut above a mid-third tumour usually lands above the azygos vein. A join that high is made more safely in the neck.
No. The neck part is always done through a short open cut on the left side. The robot does the chest and abdomen parts.
It can. Two nerves to the voice box run close by. A hoarse voice is usually temporary. Your surgeon discusses this before consent.
If the cancer has grown into the windpipe, it cannot be removed safely. Chemoradiation is then the main treatment.
Not as a routine. Neck nodes are added only for selected squamous cancers with nodes high in the chest or neck.
The neck join can narrow. A simple stretch through an endoscope usually fixes it, and it may need repeating.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of scans and pathology reports, second opinions, follow-up and surveillance.
Google: 4.9 · 53 reviews
Apollo Hospital, Bhat, Gandhinagar
Admission, robotic and open surgery, and inpatient care.
Google: 5.0 · 25 reviews
Patients travel for food pipe cancer surgery from across Gujarat, southern Rajasthan and western Madhya Pradesh.
Send the endoscopy, biopsy, airway, CT and PET-CT reports ahead of your appointment, so the consultation starts with them already read. Whether surgery suits you, the order of treatment and the approach are decided at the consultation after examination, and by the tumour board. Call +91-63590-11009 WhatsApp the office
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