A future option that's cooking;something to watch for

DanaM

I suppose I'm done researching EC surgeries for now. I understand how my husband contracted post-op pnemonia and subsequent respiratory failure. Previously, MIE EC patients had an NG tube in place for nearly 5 days. They removed my husband's NG tube a little early and the juncture where the stomach meets the small intestine was swollen and would not allow stomach bile to go down. Therefore, it had to go somewhere and it went into the lung which caused the post-op lung injury. The new protocol for a shorter NG tube stay was created because the tube interfered with the patients ability to expectorate and further increased the chances of a respiratory infection. There are reasons for early removal.

With that being said,and observing other patients, post-op MIE who had contracted pnemonia, I was even curiouser, if that's a word. There seems to be a new method of performing the MIE, which places the patient in the prone position versus the left lateral decubitus position. Early indicators have shown that there is a decrease in surgery time, better oxygenation to the patient during the procedure, a decreased risk of developing post-op pnemonia and in general gives the surgeon an opportunity to assume a better stance during the procedure which simplifies portions of an otherwise difficult surgery.

See: http://www.journalacs.org/article/S1072-7515(06)00329-2/abstract

Since this complication can easily result in a patient's death, I thought I would bring this information to this forum-for those searching out the best of the best for their loved one. For sure-there is not any definitive evidence to suggest one over the other, although there are early indicators. In time, perhaps there will be. Sadly enough, there are still folks having a hard time finding a hospital or doctor that even does the MIE, let alone offer more than one option in that department.

It is a difficult surgery and I was shocked when I learned that the removal of the esophagus or part of it and repositioning the stomach was the only ticket. I remember asking the first surgeon we met with if I could give him part of mine or did a prosethic exist for this operation? Because the blood vessels are so small, it would be too difficult to replace the piece that comes out with donor tissue. As incidents of this nasty cancer increase, I'm hoping that the research and options grow. There are too few surgeons who are dedicating their lives to perfecting an already new technique and consumed with teaching it to others to take the next steps I'm sure.

The MIE cuts just about in half, the chance of respiratory complications. This new technique has the potential to reduce this risk even more. I know for sure that if my husband had submitted to the open thoracic-type surgery and contracted post-op pnemonia to the extent that he did-he just wouldn't have survived it. This is just something for everyone to check-out. I don't want anyone to have to endure what I did and if something is cooking that has the potential to reduce the odds of it happening, I'd like to make everyone aware the news. God Bless.

BMGky

MIE or Ivor Lewis
There is no doubt that the MIE, particularly with the possible advancements mentioned above, is the preferred choice of operation. Even with this advanced form of surgery, it is the physician's skill and experience that oftentimes determines the outcome so only the most experienced in a hospital equipped to handle EC surgeries should be the goal. However, oftentimes, for many reasons, patients just cannot or choose not to avail themselves of this opportunity. My husband was one of those. The Ivor Lewis is a tough surgery even at its best BUT it offers life for those who cannot access the MIE surgery. If you go into an Ivor Lewis properly informed, have an advocate (family member caregiver) to be by your side, have read up on what to expect and steps to take to enhance recovery, you should not think yourself as having made a poor choice. Life is life, and we do the best we can in the circumstances in which we are placed. It is the oncologist's plan of care and the surgeon's skill that are the vital components and your trust in their skills. We did not formally seek a second opinion. We were so scared and wanted this horrible cancer treated as soon as possible. Yet, our staging scope was done at a ranked cancer center and confirmed the findings of our initial diagnosis so in a way, there was a second opinion. If he could have been operated on the day it was diagnosed, I was all for it. I wanted it gone! Of course, that would have been the wrong thing to do. I didn't know any better. This is just a word of encouragement for those who cannot reasonably and/or financially access the MIE surgeon/cancer center. The one caveat I would emphasize: Even if your post chemo/radiation scan shows no evidence of disease, have the surgery if medically feasible. In my husband's instance, post-op biopsy found live cancer cells in the esophagus that had been masked by the scar tissue from radiation. Summarizing: get the MIE if you can, but don't despair if that option just can't be reasonably attained.