Oesophagectomy is one of the most high risk operations performed on any patient with an average in hospital mortality of 12% in the United Kingdom (significantly less in this unit.) The mortality of the cancer itself is added to by co-morbidities associated with the causes of oesophageal cancer (smoking, obesity, alcohol excess, reflux), poor nutritional state all compounded by the effects of preoperative chemotherapy.

1. •FBP - within last month unless intervening illness
   

2. •U&E - because all have dysphagia U&E’s should be within the last 48 hours. CXR - within last month (within last 24 hours if complete dysphagia or suspected aspiration).
   

3. •ECG - within last month
   

4. •Pulmonary function tests - within one month
   

5. •Barium swallow - while barium swallow used to be mandatory, it is not usually performed where CT and PET adequately show the tumour.
   

6. •CT scan - should be arranged to determine the bulk of tumour, coeliac axis spread, liver metastases and lung metastases.
   

7. •PET scan should be available on RVH PACS
   

8. •Staging laparoscopy is routine for gastric, oesophagosgastric junction and lower third tumours.
   

9. •Oesophagoscopy - all patients are to have rigid or flexible oesophagoscopy by one of the Thoracic Surgeons before resection. It is highly advised to include a complete gastroscopic examination of the stomach to assess the extent of gastric mucosal spread and the state of the pylorus.
   

10. •Bronchoscopy - to assess whether tumour has invaded trachea or either main bronchus. Usually done at time of oesophagoscopy.
    

11. •Histology must be available at the time of resection.
    

12. •Patients are to be on a fluid diet from admission with extra calorie drinks.
    

13. •Patients with complete dysphagia are to be on nil by mouth from admission. If there has been prolonged complete dysphagia TPN may be required.
    

All Barium and CT films, endoscopy report and histology must be available in theatre.