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MIE vs Open

ChaadMN's picture
ChaadMN
Posts: 33
Joined: Sep 2011

I was scheduled to have MIE surgery next Friday. Low and behold I get a phone call from my surgeon today informing me that he would rather perform an "open" procedure. His rationale for this was that because of a previous stomach surgery I had years ago, he feels he will be able to create a better and bigger stomach tube with the open procedure (my stomach size is an issue). He also said that it would be easier to get at the nodes and could get a bigger and better sample. He also had discussed this with a couple other surgeons and said they were all in agreement with an open procedure. Again, he wants to do an open procedure only because of a previous surgery I had. So my question is to all of those who have had an open procedure, what should I expect? Does everyone think an open procedure makes sense in this situation? Just curious to see what you all think.

Tina Blondek's picture
Tina Blondek
Posts: 1561
Joined: Nov 2009

Hi Chaad and welcome to our EC discussion board. I was a caregiver for my dad. He passed from EC in March 2010. You are most fortunate to be able to have surgery. From what I have learned here, the most popular, and the best, easiest to recover from is the MIE. But...considering your situation....your doc seems to have a point. Would you consider a second opinion? You will get a lot of people responding. There are a lot of MIE patients who are survivors. Best of luck, let us now what you decide, and how you make out.
Tina in Va

BMGky
Posts: 666
Joined: May 2010

These choices are so hard. The best you can do is get all the information you can and once the decision is made, have total confidence in your surgical, treatment team.

My husband, due to prior chest surgery and mesh implant, had to have the open or Ivor Lewis surgery. His recovery was challenging as it takes time to heal the deep incisions. However, he is 20 months post op and his follow ups show no evidence of disease. It took about 6 to 7 months to get back to feeing good.

He is working full time Eats whatever he wants with the caveat of not to have liquid during mealtime and to watch how he eats soft, doughy foods and not to eat too much at one time. Life is good. Even if it is a hard surgery to recover from, it is a chance for life.

I was impressed your surgeon was taking the surgery very seriously, had consulted colleagues, and trying to choose the best option. Please let us know what is decided. If you have more questions, please ask here, as you should receive the best of the best in response. Good luck to you!! BMGky

NGC1514's picture
NGC1514
Posts: 44
Joined: Dec 2008

I had a transthoracic esophagectomy about 10.5 years ago. Returned to work part time 2 months after surgery and full time 5 months after. Return to full time was delayed by a 3 day hospitalization for pneumonia that knocked me back in my recovery. The TTE (transthoracic)is considered more invasive than the THE (transhiatal esophagectomy). Do you know which procedure your surgeon is going to perform?

Whether the "open procedure makes sense" isn't a question that should be answered here because we are not surgeons. It's a surgical decision and I'd go with the surgeon's recommendation.

Eric in Atlanta

ChaadMN's picture
ChaadMN
Posts: 33
Joined: Sep 2011

I am pretty sure it will be the THE procedure. The doctor did a good job of describing the procedure, but never really attached a name to it. So based on his description and my research, it will be the THE.

TerryV's picture
TerryV
Posts: 916
Joined: Jul 2011

I believe that it's very commendable for your surgeon to give this additional thought. I can certainly see where a previous stomach surgery would complicate things. Like this surgery isn't complex enough ;)

If you are comfortable with your surgeon and have faith in him, I believe I would want him to be at his best while operating. That would mean going with his choice of surgery. If you have *any* 2nd thoughts, get another opinion.

My husband had the THE on 09/08/11. He received a clean path on 09/13/11. He is 48, diagnosed Stage 3, T3N1M0 and his recovery has been good. Only 7 days in hospital, none of them in ICU. Surgery time was only 4 1/2 hours and just 2 months past surgery, his only real complaint is fatigue. He still tires easily. He is able to eat almost anything, but no drinking while eating. The 1st plate size is about what he took before surgery, but there are no 2nds now.

Life is good again and almost at a presurgery normal.

Best of luck to you!

Terry

NikiMo's picture
NikiMo
Posts: 346
Joined: Jul 2011

Hi Chad,

I agree 100% with Eric that the final decision needs to be made between you and your surgeon, and that may mean (and probably should mean a second opinion). I just want to share my husbands story. Jeff is 48 years old and was diagnosed with stage IIb EC this past May. He had Chemo and rads for 6 weeks and prepared for surgery. During the pre-treatment we met with 3 surgeons and consulted a fourths office by phone. 1 surgeon said Jeff could have an MIE, 2 said he should have the open procedure due to a previous surgery. Jeff had a Nissen Fundoplication 8 months before his diagnosis to repair a hernia and end his GERD. I truly believe they misdiagnosed him, but that is a different story. Jeff ad to make the decision between the MIE and the open procedure, ultimately it was the surgeon at Hopkins that helped Jeff make his decision. He sited the same reasons as your surgeon. Jeff had the Ivor Lewis on 9/6/11, he had a clean pathology report but is doing post op Chemo as a precaution against recurrence. Jeff is going to return to work part time on 11/29, so recovering from the open procedure is doable.

I hope that you can come to a decision and feel confident about that choice.

Niki

NikiMo's picture
NikiMo
Posts: 346
Joined: Jul 2011

Sorry

GerryS's picture
GerryS
Posts: 238
Joined: Aug 2010

I had the Ivor Lewis surgery at Mayo, MN in March 2010. One node was cancerous so had chemo follow-up. I was stage at IIN1M0. Recovery is challenging but doable. I was off work about 6 months but no other complications from surgery. I had an experienced surgeon so I would suggest you rely and have trust in your medical team. It will be your decision. I am about 20 months post op and still NED. I am most grateful for my medical team, my family and friends for their love and support. I wish you the best in your decision and will pray for your success.

Gerry

preacherchad's picture
preacherchad
Posts: 62
Joined: Dec 2010

Chaad,

I had the Ivor Lewis March of 2011. T2N3M0, had follow up chemo. I did have a few complications, but nothing more than what others that have had the MIE have faced. I would have the open procedure all over again if given the choice. You have to have a certain amount of trust in your surgeon. I trusted God for guidance in all decisions.

I would be happy to share my experience with you. I will send my contact info to you.

chad

Cora11's picture
Cora11
Posts: 177
Joined: Sep 2011

Chad, who is your surgeon up there ? Just curious to know. My dr. Tracey Weigel mentioned that someone in MN is doing a lot of these surgeries
Cora

pam716
Posts: 24
Joined: Oct 2011

Cora,

My dad had MIE surgery 4 weeks ago at Abbott Northwestern. His surgeon was Cassandra Anderson.

Chad,

Can you tell me who your oncologist is? My dad is seeing Dr Gesme on Friday. Did you get a 2nd opinion?

Thanks,
Pam

ChaadMN's picture
ChaadMN
Posts: 33
Joined: Sep 2011

Dr. Anderson is part of the same group that my surgeon (Dr. Dunn) works with. They must do a lot of these surgeries as a lot of us use that group.

As far as my oncologist goes, I am seeing Dr. Seng at Minnesota Oncology. I assume it is at the same place as Dr. Gesme. As far as a second opinion, I have not gotten one yet. I have felt extremely comfortable with my doctors so far, I trust their recommendations and do not see the need for a second opinion AT THIS POINT.

jim2011's picture
jim2011
Posts: 116
Joined: Sep 2011

Have you decided to go through with the open procedure on Friday? I may have missed a post or two as I have been busy at work lately. As you know I am 7+ months out from surgery at Abbott myself with the same team. I have a follow-up appointment with Julie Morphew and Dr. Johnson tomorrow, (Wednesday)10AM at the Virginia Piper Cancer Institute. Chaad, I would never violate your privacy and mention anything about you, but when I shake hands with Dr. Johnson tomorrow, I will note whether his hand feels steady and firm for you. lol
Seriously, you are young and strong and have a really great chance to beat this beast as I have. I envy your goals and attitude and I wish you the best!!
Jim

ChaadMN's picture
ChaadMN
Posts: 33
Joined: Sep 2011

I had a conversation with Julie and my doc yesterday. My doc would not recommend an open procedure unless he felt it was necessary. Julie commented that the docs would rather "play with the robot" than do an open procedure, apparently they like their toy. He knows what will work and what won't work.

I will be going ahead with the open procedure on Friday. You are, and I will be, proof that there are doctors out there besides Dr. Luketich that can save the lives of people with EC. Thanks for the well wishes Jim!

ChaadMN's picture
ChaadMN
Posts: 33
Joined: Sep 2011

Cora,

My surgeon is Dr. Daniel Dunn. He told me that he does about 60 of these per year.

Lina71912
Posts: 15
Joined: Jul 2012

I wish I had a second opinion for my mother. I thought she would do well with the surgery, she had a tranthoracic surgery, so I did not do much research for her. She reads very little English. It does not hurt to have second or even third opinion. As Mr.Marshall said this is very big surgery, my mother has the same type. I agree that the less invasive is easier to recover. When you have two incisions, they are more possibilities of infection, and you will also have chest tube. There are many uncertainty in a surgery. Like my mother, her body reacted drastically to a blood thinner with heparin, less than a week, she is completely sedateded and incubated. Less than a week her health status completely turned from day to night. Please go for a second opinion.

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

Hi, I had the Ivor Lewis in 2008. It is a rough surgery, but except for a couple of things, all went well. The recovery is longer, so of course, it would be better to have the MIE. I had complete confidence in my surgeon and I knew he did what was best for me. I am still NED. Good luck in deciding what to do,
Sandra

mrsbotch
Posts: 377
Joined: Oct 2010

Dear Chaad

From my own experience with my husband Vince who did pass away in 2011 I feel that a second opinion is in order. My husband was referred to a surgeon in Atlanta and because of the one referral he went with him. He was staged between a 1 and a 2 . The surgury went very well BUT the cancer came back.

IF we had gone to a major cancer center I really believe that Vince may be alive today.

UNLESS you really know the dr personally and know that he is the BEST in his field in EC surguries I would for sure get another opinion.
We have all written about how very bad this cancer is and that you need to have all the facts before you embark on a surgury that may or may not be right.
Of course Dr. Lukitich is NOT THE ONLY Dr who can do this procedure BUT he is ONE OF THE BEST. There are many many wonderful drs out there that perform this surgury whether it be open or the MIE But I cannot understand why anyone would not want the most experienced dr to do their surgury.

This is a BEAST of a cancer and not to be taken lightly. I am not saying you are BUT if I knew then what I know now I would have kidnapped my husband , and taken him to the VERY best dr in the country to treat him and to do his surgury. Maybe if we had done this he would still be here.

Just a few thoughts from a very sad 59 year old widow who had a husband who did not smoke or drink and was an exercise nut, but died anyhow as we did not do enough research.

Barbara

TerryV's picture
TerryV
Posts: 916
Joined: Jul 2011

All,

This is an OLD thread. Chad posted this in November 2011. He has surely had a 2nd opinion and surgery by now, 9 months later. :)

Freida
Posts: 191
Joined: Nov 2011

He did have his surgery and is doing great. He occasionally posts on the EC facebook page and is quite an inspiration. After his surgery he set himself a goal to climb a mountain in Colorado and in June he posted a photo of himself at the peek of Mt Bierstadt. What an accomplishment after chemo and major surgery (heck, what an accomplishment even without - more than I could do).

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