Initial consult with Thoracic Surgeon - What to expect and questions to be asked...

sadie1105

It has been a few days since I logged in here, but a few days can make a world of difference! As a result of much prodding on my behalf, mom will be going to see a Thoracic Surgeon at an esteemed Cancer Center tomorrow. Waiting ROUND 1 will soon come to an end. Fortunately, she has been far more accepting of my sister and my help and to talk openly about how she's doing than I expected. That feeling of isolation is waning and "getting involved" is slowing stifling the feeling of helplessness.

Unfortunately, we don't have a lot of information as yet, other than that her biopsy results were positive for esophageal cancer and after having her med records evaluated by the "powers that be" she's being seen by this thoracic surgeon for her initial consultation.

Any advise that I can give her on what to expect in this consult and critical questions that should be posed would be greatly appreciated.

paul61

Questions to ask...
Sadie,

You did not provide any staging information for your Mom so perhaps they have not completed all the testing, although an appointment with a thoracic surgeon prior to complete staging seems a bit premature.

There are a number of surgical approaches to removing the cancerous tumor and surrounding lymph nodes. How much of the esophagus, stomach, and lymph nodes that needs to be removed is a function of how extensive the spread of the cancer and where the tumor is located. They want to remove enough tissue to get clear (cancer free) margins around the tumor and remove any adjacent lymph nodes that may contain stray cancer cells.

There are three common surgical approaches:
1. The Ivor Lewis esophagectomy (IL) approach that involves incisions at the abdomen and in the back just below the shoulder blade.
2. The Transhiatal esophagectomy (THE) involves incisions at the abdomen and in the side of the neck.
3. The Minimally Invasive esophagectomy (MIE) involves a laparoscopic approach that uses a number of small incisions in the abdomen and a small incision in the neck.

There are some variations in all three approaches depending on the surgeon and hospital involved, but of the three, the MIE is the least invasive and has the shortest recovery time on average.

Questions I would ask include:

1. How many esophagectomies are done in this facility each year and what is your mortality rate and what is you’re “in hospital” infection rate?
2. How many esophagectomies do you personally perform each year?
3. What surgical approach do you recommend and why?
4. Are you familiar with the robotically assisted MIE surgical approach?
5. Do you feel I am a candidate for an MIE?
6. If not why not?
7. Do you feel I have any other medial issues that must be addressed prior to surgery or that may complicate my recovery from the planned surgery?
8. How long will my hospital stay be?
9. Will I be in ICU, if so how long?
10. I would like to obtain a second surgical opinion, do you have any recommendations?
11. Will you be a part of a team that includes an oncologist, and an internist to manage my treatment plan and recovery?
12. Can you give me the name of one of your “successful” esophagectomy patients that I could contact?

This is a big decision for your Mom and no time to be bashful. Your surgeon should not be surprised by these questions and should provide upfront answers.
Hope this helps

Best Regards,

Paul Adams
McCormick, South Carolina

DX 10/22/2009 T2N1M0 Stage IIB
12/03/2009 Ivor Lewis
2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
6/21/2010 CT Scan NED

Life may not be the party we hoped for, but while we are here we might as well dance

sadie1105

paul61 said:

Questions to ask...
Sadie,

You did not provide any staging information for your Mom so perhaps they have not completed all the testing, although an appointment with a thoracic surgeon prior to complete staging seems a bit premature.

There are a number of surgical approaches to removing the cancerous tumor and surrounding lymph nodes. How much of the esophagus, stomach, and lymph nodes that needs to be removed is a function of how extensive the spread of the cancer and where the tumor is located. They want to remove enough tissue to get clear (cancer free) margins around the tumor and remove any adjacent lymph nodes that may contain stray cancer cells.

There are three common surgical approaches:
1. The Ivor Lewis esophagectomy (IL) approach that involves incisions at the abdomen and in the back just below the shoulder blade.
2. The Transhiatal esophagectomy (THE) involves incisions at the abdomen and in the side of the neck.
3. The Minimally Invasive esophagectomy (MIE) involves a laparoscopic approach that uses a number of small incisions in the abdomen and a small incision in the neck.

There are some variations in all three approaches depending on the surgeon and hospital involved, but of the three, the MIE is the least invasive and has the shortest recovery time on average.

Questions I would ask include:

1. How many esophagectomies are done in this facility each year and what is your mortality rate and what is you’re “in hospital” infection rate?
2. How many esophagectomies do you personally perform each year?
3. What surgical approach do you recommend and why?
4. Are you familiar with the robotically assisted MIE surgical approach?
5. Do you feel I am a candidate for an MIE?
6. If not why not?
7. Do you feel I have any other medial issues that must be addressed prior to surgery or that may complicate my recovery from the planned surgery?
8. How long will my hospital stay be?
9. Will I be in ICU, if so how long?
10. I would like to obtain a second surgical opinion, do you have any recommendations?
11. Will you be a part of a team that includes an oncologist, and an internist to manage my treatment plan and recovery?
12. Can you give me the name of one of your “successful” esophagectomy patients that I could contact?

This is a big decision for your Mom and no time to be bashful. Your surgeon should not be surprised by these questions and should provide upfront answers.
Hope this helps

Best Regards,

Paul Adams
McCormick, South Carolina

DX 10/22/2009 T2N1M0 Stage IIB
12/03/2009 Ivor Lewis
2/8 through 6/14/2010 Adjuvant Chemo Cisplatin, Epirubicin, 5 FU
6/21/2010 CT Scan NED

Life may not be the party we hoped for, but while we are here we might as well dance

Questions to Ask
Thanks for the response Paul. I too am somewhat unclear as to why mom is consulting with a Thoracic Surgeon prior to staging. To date, she has had an endoscopy and a biobsy that has been evaluated by The James Cancer Center in Ohio. Not sure what they've found from the biopsy and/or endoscopy, but expect more information after her visit tomorrow. I'm hoping that they undertake necessary follow-up testing while she's there, but am skeptical that we'll be so lucky.

The questions regarding surgical procedures are greatly appreciated, although I agree, may be premature. I would be thrilled if they thought surgery was all she needed, but given her already advanced symptomatology (dysphasia, extreme weight loss, diarrhea, I suspect there's a lot more going on.)

We'll keep our fingers crossed and are definitely looking forward to getting more information regarding diagnosis and next steps from the doctor tomorrow.

linda1120

sadie1105 said:

Questions to Ask
Thanks for the response Paul. I too am somewhat unclear as to why mom is consulting with a Thoracic Surgeon prior to staging. To date, she has had an endoscopy and a biobsy that has been evaluated by The James Cancer Center in Ohio. Not sure what they've found from the biopsy and/or endoscopy, but expect more information after her visit tomorrow. I'm hoping that they undertake necessary follow-up testing while she's there, but am skeptical that we'll be so lucky.

The questions regarding surgical procedures are greatly appreciated, although I agree, may be premature. I would be thrilled if they thought surgery was all she needed, but given her already advanced symptomatology (dysphasia, extreme weight loss, diarrhea, I suspect there's a lot more going on.)

We'll keep our fingers crossed and are definitely looking forward to getting more information regarding diagnosis and next steps from the doctor tomorrow.

Surgeon
Hi Sadie,

It is normal protocol with ec to have chemotherapy and radiation prior to surgery, if the stage is not too far advanced for surgery. The chemotherapy goes after any cancer that might be in the body from the lymph system, and radiation shrinks the tumor and more. My husband's large tumor was gone and all of the lymph nodes were clean after his radiation and chemotherapy. He had the MIE surgery to remove the esophagus and 20 lymph nodes.

I wish your mother the very best!

Linda

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