Esophageal Cancer Surgery

paul61

Chemo is not fun but it is survivable

Hi Fatbiker34,

Of course none of us looked foreward to chemotherapy and radiation therapy. It is certainly not fun, but with the medications they have today to deal with the side effects it is much easier than it used to be. Your oncologist will follow your reaction to the chemotherapy drugs every carefully and prescribe other medications as appropiate to mitigate any side effects. 

During chemotherapy it is important to:

1. Advise your chemotherapy nurses of any side effects. There is no need to be a hero they can help with things like nausea, cold sensitivity, and mouth sores. Some people get these side effects, some do not. They will pre-medicate you for the most common side effects like nausea prior to your infusions and afterward so you may not even experience them.

2. It is important to stay hydrated. If you have difficulty drinking enough water to stay hydrated ask your oncologist for IV hydration three to four days after your infusions.

3. Radiation can cause some throat sensitivity, but again, if you advise your radiologist they can prescribe medication to deal with the issue.

Chemotherapy is much less difficult than it used to be 5 or 10 years ago, so if you have been listening to someone who had chemotherapy a while ago the side effect management is much better now than it used to be.

You will be closely monitored and if you are upfront about how things are going, many issues can be addressed as you go forward. 

Many of the old "infamous" chemotherapy drugs have now been replaced by immunotherapy drugs that have much less side effects but are more effective at specifically targeting the cancer cells.

MOST IMPORTANTLY, CHEMO AND RADIATION ARE TEMPORARY.....

Best Regards,

Paul 

12 Year Esophageal Cencer Survivor.

 

Fatbiker64

Start treatment tomorrow

Hi, I am 64 no symptoms until 3 months ago. Pet scan was clear, but I am nervous about chemo and radiation.Can you add any reinsurance to my nervousness? We have a great surgeon at the Mayo Clinic.Iknow these procedures have come a long way.Thanks Lance

Fatbiker64

Thank you!

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Hi Paul, thank you for your quick response!It is very much appreciated!I have read all your comments multiple times.I am having trobule with hydration , can I ask the nurse to hydrate me during chemo?I will be getting chemo on mondays and radiation the rest of the week.I do have a slight case of COPD and am a little worried about the radiation and my lungs.I do hear they have steroids to help with that?My program of treatment is for six weeks and as you did I opted for surgery.We found a great surgeon at the Mayo Clinic that does a minimally invasive surgery.You sound very knowledgeable can I communicate with you during this process? It would mean a lot to me, thanks, Lance

Fatbiker64

Hi

I sent a in-depth response and it disapeared , I am not great on these sites.Thank you very much for your considerate reply, Lance

Fatbiker64

Surgery

Hi Paul, any insight as to the minimally invasive surgery teqniques out there?, thanks, Lance

paul61

Some thoughts on Minimally Invasive Esophagectomy

Hi Lance,

 

There are three “typical” surgical approaches to an esophagectomy with gastric pull up:

The major approaches include:

First the traditional Ivor Lewis (IL) approach. In this approach two large incisions are made. One in the abdomen between the belly button and sternum and one from just under the right shoulder to the middle of the patient’s back. The abdominal incision is used to release the stomach so it can be modified and moved higher to be connected to the remainder of the esophagus. The back incision is used to enter through a space in the ribs to remove a section of the esophagus and form the new connection between the remainder of the esophagus and the remainder of the stomach.

Many surgeons around the US perform this surgical approach.

This approach is the most invasive of the approaches and typically has the longest recovery time. I had this particular surgery and I was in the hospital for 12 days. The original estimate was 10 days but I got an infection in my incisions and was there an extra two days while they gave me IV antibiotics.

 

Second the Transhiatal Esophagectomy approach. In this approach a large incision is made in the abdomen between the belly button and sternum and a smaller incision is made in the patient’s neck. The abdominal incision is used to perform the same functions as in the IL approach described above. The incision in the neck is used to remove a section of the esophagus and to form a new connection between the remainder of the esophagus and the remainder of the stomach. A more detailed description can be found here:

https://www.rogelcancercenter.org/esophageal-cancer

 Dr. Mark B. Orringer at University of Michigan Medical Center is a leader in this surgical approach.

The in hospital recovery time for this approach is shorter than the traditional IL approach and the recovery time is somewhat shorter.

 

Third the Minimally Invasive Esophagectomy (MIE) approach. In this robotically assisted approach, a number of very small incisions are made in the abdomen and in the neck. The surgeon uses the robot “arms” and cameras through the small incisions to release and modify the stomach, remove a section of the esophagus and a section of the stomach and re-attach the remainder of the stomach and esophagus. A more detailed description can be found at:

https://www.upmc.com/services/esophageal-lung-surgery-institute/treatments/esophageal-surgery/minimally-invasive-esophagectomy

Dr.  James D. Luketich at  University of Pittsburgh Cancer Institute is the leader in this surgical approach.

The in hospital recovery time for this approach is the shortest of the approaches and the recovery time is shorter as well.

 

There are a number of reasons why a surgeon may recommend one approach over another. The area around the esophagus has a number of lymph nodes connected into the lining of the esophagus; and frequently a number of these are removed to insure a clear surgical margin around the cancer and for pathological examination to validate the staging done prior to surgery. In some cases, prior surgical scar tissue and other medical issues may dictate one approach over the other.

Be sure you understand your surgeons reasoning for selecting one approach over the other. “I don’t do that approach” is not the answer you are looking for. This is MAJOR surgery and you want to have a surgeon that does MANY of these surgeries a year.

When I had my surgery, I did not even know an MIE was available. Given my experience, if I had it to do over again, I would have traveled to a major cancer center and found a surgeon who is competent in MIE.

Of course, you need to be comfortable with your surgeon and insurance is sometimes an issue.

 

Best Regards,

 

Paul

 

Fatbiker64

Thank you !

As always a huge thank you for your informative input,This obviously is all new to me.All of a sudden in August of this year I started experiencing difficulty eating.Thinking it was Gerd I saw my GP and she put me on Prilosec, then I started losing weight.I then had a endoscopy and we discovered the real issue.No symptoms prior to diagnosis.Never had heartburn in my life, it really took me by suprise.Trying to eat 2000 calories a day but it's getting tougher.Oncologist told me I might get some relief from radiation but I am only on my second week.Checked with surgeon about MIE , it is a procedure he does a lot of.Again thank you !

Grouse4

https://csn.cancer.org/discussion/157909/esophageal-cancer-surgery

Still have nausea. It has been 7 weeks. MD has me on full liquid. I started oyster crackers today myself. Removing stent next week