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The top of the food pipe runs from the neck into the upper chest. Where the tumour starts on that line decides the first treatment. This page explains that line, the operation with a join in the neck, and the parts the robot does. Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad.
Last updated: 13-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 squamous cancer of the food pipe inside the neck is usually treated with chemoradiation, not surgery. A tumour just below, in the upper chest, can be operated on.
For an upper chest tumour, our protocol uses a McKeown operation. The cut above the tumour is made in the neck, and the new food pipe is joined there.
The robot does the chest and abdomen parts. Its gain is greatest at the very top of the chest, around the windpipe, the voice nerves and their lymph nodes.
The food pipe enters the chest behind the breastbone notch. Above that point it lies in the neck. Below it, it lies in the upper chest.
Doctors call the first part the cervical oesophagus. The part just below is the upper thoracic oesophagus. Many people simply call both the upper third.
The two parts are close together, but they are treated differently. A squamous cancer in the neck sits beside the voice box. Removing it often means removing the voice box too. So our protocol treats it first with chemoradiation and keeps the voice box.
A tumour in the upper chest is different. Its top edge is below the voice box. It can be removed with a margin, and the food pipe rebuilt. This is where robotic surgery has a role.
| Where the tumour starts | Usual first treatment | Where an operation joins the pipe |
|---|---|---|
| Neck part, squamous cancer. | Chemoradiation, with the aim of keeping the voice box. | An operation is used only if cancer stays or returns. It is planned at the tumour board. |
| Upper chest part. | Treatment before surgery, then a McKeown operation. | In the neck. |
| Middle chest part, for comparison. | Treatment before surgery, then a McKeown operation. | In the neck. |
The endoscopy report records how far the tumour’s top edge is from the teeth. That single distance places the tumour in the neck or the chest.
The scope is passed through the mouth. The doctor notes the distance to the top edge, the bottom edge and the length of the tumour. Your surgeon prefers to scope you again to see the edges himself.
Two more checks matter at this height. For a squamous cancer, an ear, nose and throat doctor looks at the throat. A second cancer can hide there. A thin camera also looks inside the windpipe, because the tumour sits right behind it.
The full list of tests, and the order they are done in, is on the upper food pipe cancer pathway. This page covers the operation and the robot.
Most upper chest tumours are treated before surgery. The cell type decides whether this is chemoradiation or chemotherapy alone, and when the operation follows.
| Cell type | Treatment first | Gap before the operation |
|---|---|---|
| Squamous cell cancer, the usual type at this height. | Weekly chemotherapy with radiation, for about five weeks. | Six to eight weeks after it ends. |
| Adenocarcinoma. | Four cycles of a four-drug chemotherapy plan. | Four to six weeks after the last cycle. Four more cycles follow surgery. |
Nutrition is protected through this time. If swallowing stops, a feeding tube is preferred to a stent when surgery is planned. Breathing exercises start in the clinic, weeks before the operation.
A safe cut must be well above the tumour. Above an upper chest tumour, the only food pipe left is in the neck, so the join is made there.
Our protocol uses the McKeown operation for any tumour in the middle or upper chest. It is also used when the upper margin is a concern. Work is done in three areas: the chest, the abdomen and the neck.
The stomach is shaped into a long tube. This tube replaces the removed food pipe. It must reach all the way to the neck, so it has to be long and well supplied with blood.
For an adenocarcinoma, our protocol asks for at least five centimetres of clear food pipe above the tumour. If the edge looks doubtful, a frozen section is sent during the operation. The pathologist checks it while you are still asleep.
The chest part is done with the robot. For an upper tumour, the work reaches the very top of the chest, behind the windpipe, where the space is narrowest.
You lie partly face-down for this part. The right lung rests while the left lung breathes for both. One robotic arm holds the lung gently aside, so no metal retractor presses on it.
Four small robotic ports go between the ribs on the right side. One assistant port sits in front of them. Through them, the surgeon works from the top of the chest down to the diaphragm.
The azygos vein crosses the food pipe in the upper chest. It is sealed and divided. The surgeon then frees the food pipe off the back of the windpipe, up to where the chest meets the neck.
Here the food pipe is tucked against the windpipe on one side and the spine on the other. Straight keyhole tools meet this curve at a fixed angle. Wristed robotic tools can bend along it. The steady 3D view is magnified, so small vessels are seen before they bleed.
| Structure near an upper tumour | Why it matters | What the robot adds |
|---|---|---|
| Back wall of the windpipe. | A tear here is serious. | A close, steady view of the thin plane. |
| Both voice nerves. | They control the voice box. | Wristed tools that work beside a nerve without pulling it. |
| Azygos vein. | It crosses the food pipe. | Controlled sealing before division. |
| Thoracic duct. | It carries fat-rich fluid from the gut. | A clear view to identify it. |
Lymph nodes sit in a chain along both voice nerves. In upper tumours these nodes matter most. Clearing them without harming the nerves is the key robotic task.
The two nerves are called the recurrent laryngeal nerves. They run up the sides of the windpipe to the voice box. Cancer from the upper food pipe can spread to the nodes beside them.
The robot’s wristed tools reach around the windpipe to these nodes. The surgeon lifts the nodes off the nerve rather than pulling the nerve. Our technique notes record this as a clear robotic gain at this level.
Even with care, the voice can turn hoarse after surgery. This is usually temporary. Your surgeon discusses voice change with you in person before you consent. If it happens, a voice and swallow check follows, and thicker fluids are used for a while.
Nodes in the chest and upper abdomen are always removed. Nodes in the lower neck are added only for selected squamous cancers with nodes high in the chest or neck.
| Node area | When it is cleared | Done during |
|---|---|---|
| Chest, along the food pipe, the windpipe and the voice nerves. | Always. | The robotic chest part. |
| Upper abdomen, around the stomach vessels. | Always. | The robotic abdominal part. |
| Lower neck, beside the voice nerves. | Selectively, for squamous cancer with nodes high in the chest or neck on scans. | The open neck part. |
The third field adds time and some risk to the voice. That is why our protocol keeps it for patients whose scans point to it. The pathologist counts the nodes, and our protocol sets a minimum number.
For the abdominal part you are turned onto your back, and the robot is docked over the upper abdomen. The stomach is shaped into a narrow tube long enough to reach the neck.
Four robotic ports and one assistant port go across the upper abdomen. A robotic arm can lift the liver, which gives a clear view of the top of the stomach.
The vessels along the stomach’s greater curve feed the tube. They are kept with great care. The vessels on the upper side of the stomach are tied at their root, with their nodes.
Staplers then shape the tube. A dye given into a vein glows under the robot’s camera. It shows whether the tip of the tube has good blood flow. A small feeding tube may also be placed into the bowel.
The neck part is done through a short cut on the left side of the neck. It is not robotic. The tube is brought up and joined to the food pipe there.
For an upper tumour, the cut on the food pipe is high in the neck. The surgeon finds the food pipe beside the windpipe and divides it well above the tumour. The tube is joined to it with stitches or staples.
A neck join has one clear advantage. If it leaks, the neck wound can be opened at the bedside to drain it. A leak in the chest is harder to manage.
A neck join also narrows more often. If food sticks weeks later, the join is stretched through an endoscope. This may need to be repeated.
All three approaches remove the same food pipe and nodes. They differ in cuts, blood loss, the view near the voice nerves, chest infections, hospital stay and return to work.
| Open | Keyhole | Robotic | |
|---|---|---|---|
| Chest cut. | A long cut between the ribs. | Small ports. | Small ports. |
| Neck cut. | Yes. | Yes. | Yes. |
| Blood loss. | More. | Less. | Less. |
| View at the top of the chest. | Deep and narrow. | Magnified, flat. | Magnified, 3D and steady. |
| Nodes along the voice nerves. | Cleared by hand. | Straight tools. | Wristed tools. |
| Nodes cleared overall. | The same. | The same. | The same. |
| Chest infections. | More. | Fewer. | Fewer. |
| Hospital stay. | Longest. | Shorter. | Shorter. |
| Return to work. | Later. | Sooner. | Sooner. |
| Cost. | Lowest. | A little higher. | Highest, 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 upper cancers need no operation first, and some need open surgery. The neck line, the windpipe, past treatment and your lungs decide this.
| Situation | Usual plan |
|---|---|
| Squamous cancer inside the neck. | Chemoradiation first, keeping the voice box. |
| Cancer grown into the windpipe, the aorta or the spine. | No operation. Chemoradiation is the main treatment. |
| An operation that must also remove the throat and voice box. | Open surgery, with the head and neck surgeons. |
| Cancer that stays or returns after chemoradiation alone. | Surgery is considered by the tumour board. It is often open, because of scarring. |
| A past right chest operation. | Open surgery is considered. |
| Very weak lungs on breathing tests. | Breathing training first. Open or another plan is considered. |
| Too unwell for a major operation. | Chemoradiation, or a gentler plan. |
During surgery, the plan can also change. If the tumour is stuck to the windpipe and the plane is unclear, the surgeon may change to open surgery. That is a safety decision, not a failure.
You sit out of bed on the evening of surgery. Feeds start through the small tube the next day. Drinking begins only after the neck join is checked.
| When | What happens |
|---|---|
| Day of surgery. | Breathing tube out early. Head raised. Sitting out of bed. Breathing exercises begin. |
| Next day. | Walking two or three times. Slow feeds through the tube. Chest physiotherapy. |
| Second and third days. | Feeds increased to target. 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. Checks before going home. |
Some signs need action the same day. These are redness of the neck wound, fever, a fast pulse or an irregular heartbeat. Coughing when you drink, with a hoarse voice, is also checked at once.
You go home eating soft food or on tube feeds, with a family member trained to help. Voice and swallowing are checked at each visit. Work returns in stages.
A dietitian writes your meal plan before discharge. Eat five or six small meals a day. Sleep with the head raised, because the new food pipe has no valve against acid.
Food can rush through quickly at first. Weakness or dizziness after a meal is a sign of this. Smaller meals with less sugar help.
Desk work usually returns before heavy work. Lifting waits until the chest, abdomen and neck have healed. Your own return date is set at the follow-up visits, not on a fixed calendar.
The tissue report is discussed at two weeks. It decides whether you need immunotherapy, more chemotherapy, or careful watching. Visits then continue for ten years.
| Report 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, later stretching of the neck join 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. You can also call the office on +91-63590-11009 before you travel.
A squamous cancer inside the neck sits beside the voice box. Chemoradiation first can treat it and keep the voice box.
A safe cut above an upper chest tumour lands in the neck. There is no food pipe left in the chest to join to.
No. The neck part is always a short open cut on the left side. The robot does the chest and abdomen parts.
Only in selected squamous cancers whose scans show nodes high in the chest or neck. Otherwise the chest and abdominal nodes are cleared.
It can. Both voice nerves run close to an upper tumour. Hoarseness is usually temporary, and your surgeon discusses it before consent.
A neck join can narrow. Stretching it through an endoscope usually helps, 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 report with the distance of the tumour from the teeth, the biopsy, the throat and airway checks, and the CT and PET-CT reports ahead of your appointment, so the consultation starts with them already read. Whether surgery suits you, and the order of treatment, are decided at the consultation after examination, and by the tumour board. Call +91-63590-11009 WhatsApp the office
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