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Ivor Lewis

crystalbay
Posts: 39
Joined: Aug 2010

I keep seeing this surgery slammed over & over and it's getting to me. I did have this surgery three months ago and have had many complications but these were due to causes unrelated to the type of surgery I had. I have a problem believing that the finest medical center in the modern world - Mayo Clinic- would consistently prefer this surgery over a less invasive one without solid, proven research as to its efficacy. I do not believe that the only or primary reason it's still the top choice is simply because "it's been done for half a century". Mayo is at the cutting edge of the best possible procedures. If the MIE was so superior, I believe Mayo would be employing it more of the time than not.

I'm having a consult with the head of thoracic surgery in two weeks and plan to inquire more about the MIE. I'll report back with his response on this site, but in the meantime I question the helpfulness of those who'd only urge one method over another. I have no back pain or any other problems from the surgery itself, by the way.

tb7
Posts: 57
Joined: Sep 2009

Hi Nancy!

I really wonder if one method is better than another. We went with what our surgeon (Dr. Philip Linden, Division Chief, Thoracic & Esophageal Surgery, University Hospitals, Cleveland, OH) recommended, and it was the full surgery. My husband only spent a week in the hospital, recovered fine, and has really had few post-surgical difficulties, the main one being getting used to eating differently. Dr. Linden felt the more extensive surgery was the best shot at a cure, so we went for it, and we have no regrets nor misgivings about the method we chose. The Mayo Clinic may be of the same belief about treatment protocol. I will be interested in the feedback from your discussions in two weeks!

Trisha

crystalbay
Posts: 39
Joined: Aug 2010

Being so new to this site, I didn't want to offend anybody but after going over dozens of older
posts, I felt compelled to say something. I'm realizing that "older" posts are just as relevant as fresh ones because the cancer-related subjects don't change all that much! I'm still wondering why my "T2 N1 M0" earned me Stage III when the identical staging was put at
Stage IIb for another member?

As to the Ivor Lewis, it is a much more difficult surgery from which to recover due to the
extensive incisions but again I'd have to see the scientific research supporting any conclusion that of the three types of possible surgeries, Ivor Lewis is the least desirable!

Crystalbay

tb7
Posts: 57
Joined: Sep 2009

Hi Cystalbay!

Thought you might be interested in checking out the link to the most recent National Cancer Institute Staging Information for Esophageal Cancer . . .

http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/HealthProfessional/page4

Seems like you will have lots to talk about when you meet with your doctor! T2N1M0 doesn't seem like it should earn you a Stage III, as least as I read the staging info, but who knows, maybe there was something that indicated Stage III. Let us know how your doctor responds to your inquiries!

Trisha

sandy1943's picture
sandy1943
Posts: 883
Joined: Jun 2010

Sherri., Like I've stated before I did not find this site until recently. I didn't know there were different surgeries. I also had the ivor lewis and I did well afterwards. I had one or the top thoracic surgeons in the country. He never mentioned any other surgery I don't know if I was a candidate or not. I also am going to discuss this with him. I feel alot of what I've learned from this site, I could have found out on my own, but I've always excepted what the drs say--Not anymore. I had from Nov. until May to have asked the questions You posted, but my head was buried in the sand.
My surgery is behind me--I'm doing well, but I do want to encourage others to ask them questions--Be sure your treatment is the best for you. This is YOUR body and YOUR life, so do all you can to hold on to it.
SANDRA

crystalbay
Posts: 39
Joined: Aug 2010

Sherri,

What an important, articulate post you've written. I'd like to see this list printed out and handed to every single newly diagnosed EC patient across the land. Seriously.

My EC was not early-stage but Stage III. This more than likely explains the "rush" to Ivor
Lewis. I couldn't agree more with the reasoning behind treating earlier stage cancers with
MIE. It only makes common sense. The night before my first EUS at Mayo, the docs believed that recision would take care of the whole problem. We celebrated for hours. The next afternoon, after the EUS, I was told the EC was Stage III. There was never any discussion of a MIE; only chemo/radiation, then surgery. I will ask Dr Allen why I was not a candidate for the MIE anyway but I would think that the head of Mayo's thoracic surgery dept. would be the most knowledgeable as to whether or not that was a viable option!

Again, your questions need to be printed & handed out liberally before people are forced to make such a devastating decision!!!

Thank you so much,

Crystalbay

unclaw2002's picture
unclaw2002
Posts: 664
Joined: Jan 2010

First, I want to welcome you to this Board and thank you for taking the time out of your days to share with others. This is a caring group of people who are really there for each other through some of the darkest days any of us could ever dream experiencing.

Now on to your recent post and questions about some on this board who are proponents of the MIE. The urging on this board is to educate patients that there are alternatives out there and that there isn't only one surgery available. All advice is given with the caveat that one should always consult with the doctor, should consider the patient’s condition and individual circumstances. There is not any one perfect or right answer. So at the end of the day it really is about sharing what worked for others and offering those options/information. And so many patients never knew that there was another surgical option until it is too late and they have already had the Ivor Lewis.

A patient should make a decision on what course of surgery to pursue after a full explanation of the options and a weighing of the risks, complications, prognosis and any other relevant factors. This is a personal decision. What has happened to too many on this board is that they were never given the information, the facts or offered a choice and had the Ivor Lewis because it was the only option presented. And to remind us all that the "surgeon" isn't God and you have a right to understand fully what is going on with your body.

Change and innovation often causes resistance. Physicians with long track records who have only tried on type of surgery may return to their comfort zones. And if possible because of a lack of experience many surgeons don't mention the MIE, nor do they discuss it with patients because they do not have the facilities to perform the procedure nor the expertise. Not every surgeon is qualified to do MIE procedures --- and if your thoracic surgeon can't do the procedure I would guess it is unlikely he will refer you to another colleague for surgery when in his mind the Ivor Lewis will do just fine or he doesn’t believe the new research that indicates that long-term survival rates are similar for both procedures.

Ask your surgeon which he would prefer if it were his body ... For me and all the medical literature I have read the less you cut, the less trauma to the body and surrounding tissues the better the post-op outcomes and the less pain to the patient. And if given the option I would choose the less invasive method – admittedly that is my bias – wanted to put that out there so there are no misunderstandings as to my position.

Over the last several years MIE has gained in stature and reputation and use. All the major cancer centers have developed MIE departments and increased staff surgeons who specialize in performing MIE procedures for EC.

You question the research and efficacy of the procedure. Here are some links for you to review and obtain some information, facts and data. Even though you have already had your surgery I am sure there will be many opportunities to speak to others and help. I hope after you have had a chance to review these materials you might better understand some of the concerns of others on the Board. If you have questions I would urge you to ask your medical professionals and others on this site.

Good luck,
Cindy

1. “Minimally Invasive Surgical Treatment of Esophageal Carcinoma” Gastrointest Cancer Res. 2008 Nov–Dec; 2(6): 295. PMCID: PMC2632565 Copyright © 2008 by the International Society of Gastrointestinal Oncology (ISGIO). All rights reserved
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632565/

2. “Minimally Invasive Surgery for Esophageal Cancer Reduces Mortality Rates, Length of Hospital Stays”
ORLANDO, May 31, 2009 – Patients with esophageal cancer who require surgery may benefit from having minimally invasive surgery instead of an open esophagectomy, or removal of the esophagus, according to a University of Pittsburgh Cancer Institute (UPCI) phase II study. The results will be presented May 31 at the 45th annual meeting of the American Society of Clinical Oncology (ASCO) in Orlando, Fla. This study was sponsored by the National Institutes of Health.
http://www.upmc.com/MediaRelations/NewsReleases/2009/Pages/Minimally-Invasive-Surgery-Esophageal-Cancer.aspx

3. HERE ARE THE DETAILS SETTING UP THE CLINICAL TRIAL . . . which began in March of 2004
“Minimally Invasive Esophagectomy (MIE): A Multicenter Feasibility Study”
http://www.thirdage.com/hc/ct/9867/clinical-trial-listing

4. “Minimally Invasive Surgery Provides New Options for Patients with Esophageal Cancer” 2008
http://www.yalecancercenter.org/news/2008stories/boffa.html

5. “The Surgical Management of Esophageal Cancer” Ziad T. Awad, MD, FRCSI, FACS
http://www.dcmsonline.org/jax-medicine/2010journals/EsophagealCancer/SurgicalManagement.pdf

6. “Minimally Invasive Surgical Treatment of Esophageal Carcinoma” Gastrointest Cancer Res. 2008 Nov–Dec; 2(6): 283–286. PMCID: PMC2632570 Copyright © 2008 by the International Society of Gastrointestinal Oncology (ISGIO).
R.J. Mehran, MD: Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632570/

7. “Minimally Invasive Surgery for Esophageal Cancer” Moffitt Center - 2008
http://www.jnccn.org/content/6/9/879.full.pdf

8. “Minimally invasive esophagectomy for esophageal cancer: Analysis of recurrence patterns and prognostic factors of recurrence” Australia 2008. http://espace.library.uq.edu.au/view/UQ:197421

9. “Open Versus Minimally Invasive Esophagectomy: Trends of Utilization and Associated Outcomes in England” A study from 1996 – 2008. http://journals.lww.com/annalsofsurgery/Abstract/2010/08000/Open_Versus_Minimally_Invasive_Esophagectomy_.12.aspx

10. Sloan Kettering site listing its surgeons who use Minimally Invasive Surgical techniques. http://www.mskcc.org/mskcc/html/86502.cfm#ESOP-SUR-MIN

11. MD Anderson Q& A site about MIE’s http://www.mdanderson.org/publications/cancerwise/archives/2007-october/cancerwise-october-2007-q-a-minimally-invasive-esophagectomy.html

12. The Northeast Florida Medicine Magazine– spring of 2008 – Esophageal Cancer --- a selection of articles on issues related to EC.
http://issuu.com/roblee/docs/duvalcountyspring2010journal

Donna70's picture
Donna70
Posts: 920
Joined: Aug 2009

Gee, having had the open surgery and my share of complications, I would still choose it. I did ask the question why my surgeon was not doing the MIE and he gave me an answer that I could live with. I think as mentioned above, it all depends on the severity and location and whether you have lymph node involvement. I wanted him to look around carefully and find out if it could be in my major organs. Also, there was no way if I chose MIE that I could go to another state. My dear hubby was postponing retirement to keep my medical coverage active and he could not accompany me nor could anyone else in my family. But I went with the hospital, St. Josephs in Baltimore because it also had won the National Cancer Institute grant, the only place in Maryland to get it. This is with Johns Hopkins and University of Maryland in the mix!! There is no right or wrong in this issue. It is a matter of trust in your particular doctor and hospital and frequency of surgery, which in my case was one esophagectomy practically a week or week and a half. Sad to say Maryland has a high EC rate. One of my best friends had wonderful treatment the year before at St. Josephs for lung cancer and I had seen the quality care in action. It is wonderful to have survived!!! Let's just be happy for all of us that have gone thru either surgery and are here to discuss it, some of our friends are not here sadly to discuss the merits of either one. take care, prayers for all,
Donna70

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