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Second Opinion choices for esophagectomy GE Junction

gkelly
Posts: 6
Joined: May 2013

My husband, 62 and in great (otherwise) health has adenocarcinoma of the GE Junction. It's a Stage 3, N1, M0. He has one more round of chemo and he'll need an esophagectomy. Our oncologist has recommended a doctor, a surgical oncologist, at the Univ. of Alabama at Birmingham. I'd like to have another option on the surgeon mainly because I'm reading that "high volume" institutions are the best. "High volume" is more than 20 of these surgeries per year, from what I've read. We won't know how many of these the UAB doctor has done until we talk to him. Mayo advertizes more than 150, which is probably an institutional number. I haven't seen numbers for MD Anderson.

Anyone out there have a recommendation?

 

Thanks,

paul61's picture
paul61
Posts: 1105
Joined: Apr 2010

I would assume you are interested in a facility that offers robotically assisted minimally invasive esophagectomies. Facilities that survivors here have reported positive results about include:

 UNIVERSITY OF PITTSBURGH CANCER INSTITUTE

http://www.upmcphysicianresources.com/cme-course/minimally-invasive-esophagectomy

 MD Anderson Cancer Center

 http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/cancer-treatment/surgery/minimally-invasive-surgery/index.html

 Slone-Kettering Cancer Center

 http://www.mskcc.org/cancer-care/adult/esophageal/surgery

Mayo Clinic

 http://www.mayoclinic.org/annualreport/2011/stories/jorge_rivera.html

 Any of these facilities would be considered “high volume” facilities. If the surgeon at UAB does not have training or background at one of these facilities I think I would continue searching until I found a surgeon that did.   

Best Regards,

Paul Adams

McCormick, South Carolina

DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009

Cisplatin, Epirubicin, 5 FU - Three Year Survivor

gkelly
Posts: 6
Joined: May 2013

Thank you for listing these. Yes, the doctor was at Sloan Kettering. And thank you for listing your chemo. That's what my husband is on now. We both want the minimally invassive surgery. Is there a robotic and a non-robotic minimally invassive esophagectomy? I haven't researched that.

 

Thanks again,

paul61's picture
paul61
Posts: 1105
Joined: Apr 2010

There is a difference between a robotically assisted minimally invasive esophagectomy (MIE) and a standard laparoscopic MIE. While all MIE surgery is laparoscopic (done through a series of small incisions) a robotically assisted MIE uses a robotic platform to assist the surgeon in operating in very small clearance locations. The robot can allow the surgeon to be more precise in his/her operating technique and reduces surgeon fatigue (a typical esophagectomy with gastric pull up is a 6 1/2 to 7 hour operation). Of course the technology is expensive and the learning curve for surgeons is steep; so not all hospitals offer this approach.

Best Regards,

Paul Adams

McCormick, South Carolina

DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009

Cisplatin, Epirubicin, 5 FU - Three Year Survivor

imag8or63
Posts: 1
Joined: May 2013

I had a robotic MIE procedure for espophageal adencarcinoma of the EG junction on January 11th.  Living in the Metro Orlando area, I interviewed two surgeons locally after completing chemo and radiation November 30th.  Orlando Regional Medical Center has an adjunct MD Anderson campus.  THe other option is Florida Hospital, affilatiated with the Seventh Day Adventist Church. The main Florida Hospital in Orlando has a nationwide reputation as one of the best facilities for coronary bypass graft surgery (CABG).  I had a triple bypass there in 2001, so was familiar with the hospital. 

But I never could get a firm handle on just how many of these procedures were done at either hospital.  A family member is an RN in a nerological PCU at one of the area Florida Hositals and and MD who frequents her unit sugested I look into the Shands Teaching Hospital at the University of Florida in Gainesville.  I'm a UF graduate (1963), so we made the trip and spoke with Dr. Kfir Ben-David.   After the interview, there was no question where to go.  Dr. Ben-David performs an average of 8 to 12 of these robotic MIE procedures per month.  Here's the Shands website  https://ufandshands.org/   You can enter his name in the websites search engine field, and it will bring up his surgocal specialty areas.  Shands has negotiated discounts with a number of hotels in the area.  Here's a link to the hotels https://ufandshands.org/shands-uf-patient-guide/where-stay 

Good luck

gkelly
Posts: 6
Joined: May 2013

Thank you both for the information. I'll add Dr. Ben-David to our list of doctors and Shands to our list of hospitals. Both of our sons are UF grads. I appreciate the information on the robotic surgery.

 

Thanks for the good luck wishes. I know we need them.

Christine135's picture
Christine135
Posts: 71
Joined: May 2012

My husband's surgeon is Dr. Jeffrey Peters here in Rochester New York. He is at Strong Memorial Hospital and is ranked one of the top two esophageal surgeons in the country. We were lucky to have him located where we live. My husband had his escophagectomy in August 2012 and while the cancer has returned, it is localized and chemo should take care of it. He has been on herceptin since last year as his tumor tested positive for breast cancer did its job to keep it localized and not spread through the body.

Good luck to you and your husband. 

gkelly
Posts: 6
Joined: May 2013

thank you! I just looked Dr. Peters up and have added him to my list. Third round of Epirubicin, Cisplatin and 5-FU (ECF) is this coming Wednesday, but the FU is infused for another 3 weeks. After that, we'll see the doctor at UAB. I am going to ask a lot of questions about the UAB doc, how many esophagectomies, and since my husband has one lymph node involved, if he's done that. The UAB doctor is a surgical oncologist, not a surgeon, but we do want someone who has performed a lot of these surgeries. I really don't care where we go. I realize that we'll be far from home and trips are not fun when someone feels bad, but we want to make the best choice possible. UAB is about 4.5 hours by car, Shands in Gainesville about 6. NY would require flying. 

Again, thank you.

flmo's picture
flmo
Posts: 72
Joined: Jan 2011

Another place to consider is the University of Pittsburgh Medical Center and Dr. James Luketich.  Dr. Luketich is the pioneer of Minimally Invasive surgery-MIE. He has done well over 1000 MIE's.  My husband had MIE surgery at the UPMC in Feb. 2011.  We were very happy with Dr. Luketich and the staff.  We flew from Fort Myers FL in order to get the best surgeon ( in my opinion). 

Best of luck in your search.

 

Maureen

gkelly
Posts: 6
Joined: May 2013

Thank you!. I've added Dr. Luketich to our list. We'd be flying from Florida, too, but we're in Pensacola, so I'm sure we'd have at least one if not two layovers to go anywhere. Could you elaborate on how long you were there for tests/eval? For surgery? Did you go back for checkups, or does that fall under the care of you local oncologist?

Thanks again.

flmo's picture
flmo
Posts: 72
Joined: Jan 2011

We had one layover from Fort Myers.  Most tests were done here with local doctor.  We flew to Pittsburgh 3 days before surgery was scheduled.  We met Dr. Luketich for the first time the day before surgery,but he called my husband at home the week before we left.  It was a ncie touch and one he uses for all of his out of town patients. They have a wonderful place for patient's families to stay called Family House.  It's sort of a Ronald McDonald house for adults. They even provide transportation to the hospital by shuttle bus. We were in Pittsburgh for about 3 weeks.My husband was in the hospital for a week and the rest of the time was spent recuperating at the Family House before we could fly home.  We went back to Pittsburgh for the first checkup. Dr. Luketich's staff was very caring and easy to deal with before and after surgery.  

 

Maureen

sistersadie
Posts: 1
Joined: Jul 2012

My husband was considering UAB for MIE last year after his initial chemo/radiation was finished.  Our research and contacts said Dr. Rob Cerfolio was the thoracic surgeon at UAB who does the robotic MIEs.  We heard great things about UAB and Dr. Cerfolio.  The drive was about the same distance for us to go to Birmingham or Houston, so we decided to go to MDA instead, thinking if it came down to needing more options, they have everything MDA.  We thought they would have more trials and things like that if we needed them.  We consulted with Dr. Stephen Swisher the chief of thoracic surgery at MDA.  He does not do MIE, instead does the open Ivor Lewis. There are surgeons at MDA who do MIE, but i don't think they do it robotically, but not certain.  My husband was found to have mets to distance lymph nodes and so, being stage 4, was not a candidate for surgery after all. For the past 8 months he has been on chemo under the care of an oncologist at MDA and in consult with our local oncologist here in Biloxi where he received all treatments. He continues to work fulltime, so chemo is done here and we go out to MDA every 2 months for tests.  Incidentally, we were there this week and he received a CLEAR scan! NO ACTIVE CANCER anywhere showing on PET scan! No more chemo for now!  I just had to get that in as we are wanting to shout it from the rooftops! :) 

Good luck! 

 

gkelly
Posts: 6
Joined: May 2013

The doctor my husband will see is Dr. Martin Heslin at UAB. I don't know what type of surgery he does. I'm going to ask our oncologist a lot of questions on Tuesday, when my husband goes for his appointment before the final round of chemo. When we asked him about the minimally invassive surgery, he said that was really up to the surgeon, which makes sense. I just looked up Dr. Cerfolio. He's in the same practice as Dr. Heslin. Like you, we wnt to make the best decision and don't care how far we have to go.

 

Thank you for sharing. And Yay!!!! on not having to go through more chemo. Best wishes...

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