en-bloc esophajectomy....has anyone had this or heard of it?

NikiMo

Hi all,

In doing some research today I found a few articles about en-bloc esophajectomies, in this procedure they are able to remove a higher number of lymph nodes than in the THE surgery. The articles stated that the en-bloc has higher 5 year survival rates because more nodes are removed. Has anyone had this en-bloc type of procedure or know of a surgeon who does this? I would love to speak with someone before my husband goes into surgery next week.

Thanks

Niki
Wife of Jeff T2N1M0

Joel C

How many nodes removed?
Hi Niki,
I’m not familiar with the en-bloc esophagectomy but I have to believe the more nodes removed the greater the chance that the cancer will not return. With my MIE I had 15 nodes removed. One of the first questions I had for the surgeon when I awoke was how many nodes were removed, when he said 15 my heart sank because I had been reading that many patents were having around 25 and as many as in the thirties removed. Well sure enough I ended up with recurrence in a node on my windpipe at the right clavicle. I can’t help wonder if my surgeon had taken more modes if things may have worked out different.

I would be curious to know how many nodes esophagectomy patents had removed during their surgery and the outcome going forward?

Joel

annalan

Joel C said:

How many nodes removed?
Hi Niki,
I’m not familiar with the en-bloc esophagectomy but I have to believe the more nodes removed the greater the chance that the cancer will not return. With my MIE I had 15 nodes removed. One of the first questions I had for the surgeon when I awoke was how many nodes were removed, when he said 15 my heart sank because I had been reading that many patents were having around 25 and as many as in the thirties removed. Well sure enough I ended up with recurrence in a node on my windpipe at the right clavicle. I can’t help wonder if my surgeon had taken more modes if things may have worked out different.

I would be curious to know how many nodes esophagectomy patents had removed during their surgery and the outcome going forward?

Joel

Hi Joel
So very sorry to
Hi Joel

So very sorry to read of your recurrence. My husband Alan, aged 68, had the Ivor Lewis March 2010, he had 24 nodes removed and 7 were cancerous. He has had just one CT scan since which was NED and live in hopes that it will remain that way, but of course we never know. We Wish you all the luck in the world for the future.

Ann (2)
T3N1M0

annalan

Joel C said:

How many nodes removed?
Hi Niki,
I’m not familiar with the en-bloc esophagectomy but I have to believe the more nodes removed the greater the chance that the cancer will not return. With my MIE I had 15 nodes removed. One of the first questions I had for the surgeon when I awoke was how many nodes were removed, when he said 15 my heart sank because I had been reading that many patents were having around 25 and as many as in the thirties removed. Well sure enough I ended up with recurrence in a node on my windpipe at the right clavicle. I can’t help wonder if my surgeon had taken more modes if things may have worked out different.

I would be curious to know how many nodes esophagectomy patents had removed during their surgery and the outcome going forward?

Joel

Hi Joel
So very sorry to
Hi Joel

So very sorry to read of your recurrence. My husband Alan, aged 68, had the Ivor Lewis March 2010, he had 24 nodes removed and 7 were cancerous. He has had just one CT scan since which was NED and live in hopes that it will remain that way, but of course we never know. We Wish you all the luck in the world for the future.

Ann (2)
T3N1M0

chemosmoker

annalan said:

Hi Joel
So very sorry to
Hi Joel

So very sorry to read of your recurrence. My husband Alan, aged 68, had the Ivor Lewis March 2010, he had 24 nodes removed and 7 were cancerous. He has had just one CT scan since which was NED and live in hopes that it will remain that way, but of course we never know. We Wish you all the luck in the world for the future.

Ann (2)
T3N1M0

There's a limit...And En-Bloc Surgery.,,,
Joel,
My thoracic surgeon (supposedly one of the best in the area?) said that they cannot take too many nodes out or there will be many other complications. I would like to know more about that area of the surgery. Anyone?
I found this about the en-bloc surgery in all of my reading and/or research.
-Eric
------------------------------------------------------------------------------------------
En Bloc Esophagectomy
What is an En Bloc Esophagectomy?
An En Bloc Esophagectomy is done in patients who are being treated for cancer of the esophagus. It is a radical operation that takes out the esophagus, a portion of the stomach and all of the lymph nodes in the chest and abdomen. The surgery is done through the neck, chest and abdomen. An incision is made on the right chest and the esophagus is mobilized. All of the lymph nodes are taken out of the chest. An incision is then made on abdominal wall and small incision is placed in the left neck. The stomach and esophagus are mobilized and all of the lymph nodes are removed from the abdomen. The stomach is cut into the shape of a tube using surgical staples. The esophagus and cut portion of the stomach are pulled out through the neck incision and removed. The newly shaped stomach is brought up through the chest and sewn to the small piece of the esophagus that is left behind in the neck. The stomach will now function as the esophagus used to.

Will I need to have anesthesia?
Yes.

How long will it last?
The surgery takes about 6-8 hours.

Will anything be removed, replaced, etc?
Yes, the esophagus is removed and replaced with the stomach. Sometimes it is necessary to replace the esophagus with the colon, small intestine or a piece of skin taken from the forearm.

Where will the incision(s) be made?
An incision is made on the back of the right chest, the abdominal wall and the left neck.

Will any devices/sutures/staples be implanted and will they need to be removed?
Permanent sutures will be used to sew the esophagus to the stomach and surgical staples will be used to fashion the stomach into a tube.

Will I have any tubes or drains after surgery?
Yes, you will have a small tube coming out of your nose that drains the fluid in your stomach. It will be removed 5 days after surgery. You will also have a drain in your right chest that will come out in 3-5 days. A small drain will be in your neck and will be removed 1-2 weeks after surgery in the doctor’s office. You will have a small feeding tube in your stomach that you will go home with and use it to supplement your feeding and medications. It will be removed approximately 2 months after surgery once you are eating well and gaining weight.

How long is the stay in the hospital?
You will need to stay in the hospital for 10-14 days. You may spend 1-3 nights in the intensive care unit depending on how well you recover.

How long before I will be eating solid foods?
For the first week after surgery you will be drinking liquids only. In the second week you will start to eat soft foods. By 2 months you can eat a normal diet.

How long before I am back to my normal levels of exercise?
It is recommended that you refrain from strenuous activities and heavy lifting for about 2 months.

When will I be back to my normal routine?
Usually by 2 months you can return to your normal routine.

What follow up is necessary?
A follow up visit 2 weeks after surgery is necessary.

How will this affect my life in the long-term?
After some time your life will return to normal. However, some permanent alterations in lifestyle are recommended.
1) Small frequent meals, avoiding steak or heavy meats.
2) Elevate head of bed 30 degrees at all times.
3) Sitting in a chair following meals for at least one hour.

NikiMo

Joel C said:

How many nodes removed?
Hi Niki,
I’m not familiar with the en-bloc esophagectomy but I have to believe the more nodes removed the greater the chance that the cancer will not return. With my MIE I had 15 nodes removed. One of the first questions I had for the surgeon when I awoke was how many nodes were removed, when he said 15 my heart sank because I had been reading that many patents were having around 25 and as many as in the thirties removed. Well sure enough I ended up with recurrence in a node on my windpipe at the right clavicle. I can’t help wonder if my surgeon had taken more modes if things may have worked out different.

I would be curious to know how many nodes esophagectomy patents had removed during their surgery and the outcome going forward?

Joel

Worthy of a new post I think...
Hi Joel,

I think asking that question out to the group would be very interesting, and could give us some real life data when we talk to surgeons. What I found with the en-bloc is that it is the most evasive of the different types of esophagectomies. It done by using three fields of surgery instead of two. What this allows the surgeon to do is get at more lymph nodes, in particular the abdominal and mediastinal. They not only remove the tumor but do a full lympandectomy. The papers I read gave considerably higher survival rates with that type of procedure over the THE. I plan on calling Jeff's surgeon tomorrow, he is an expert in the field and I want to just pass this info by him and get his take. The problem with the en-bloc is that it is radical and is therefore more dangerous. It seems like the point is get as many nodes as possible. I know that Olya's husband had an MIE and they were able to get about 30 nodes. I don't necessarily want Jeff to have a radical surgery, but I would like the surgeon to tell me how many nodes he usually takes.

I would be most curious to know how many nodes are taken from long term survivors, I think Williams number would be interesting as he was staged T3N1. I think you should pose the question.

Has your biopsy results been returned already? If not, please think positive thoughts about your PET scan, it could be a false positive. If it has come back as positive I am truly sorry, I know no one wants to hear those words. I just wanted to tell you that I know of another support group that has a gentleman with nodes metastisis, he was clean for five years and one popped up just outside of the radiation field. He has been on xeloda (oral version of 5fu) off and on for two years. He seems pretty upbeat, doesn't complain of side effects. They are managing his disease. I can PM you the address of the group if you'd like. Please don't lose hope, I know it is wise to be realistic, but I think it is also equally important to keep hope alive.

Niki

Joel C

NikiMo said:

Worthy of a new post I think...
Hi Joel,

I think asking that question out to the group would be very interesting, and could give us some real life data when we talk to surgeons. What I found with the en-bloc is that it is the most evasive of the different types of esophagectomies. It done by using three fields of surgery instead of two. What this allows the surgeon to do is get at more lymph nodes, in particular the abdominal and mediastinal. They not only remove the tumor but do a full lympandectomy. The papers I read gave considerably higher survival rates with that type of procedure over the THE. I plan on calling Jeff's surgeon tomorrow, he is an expert in the field and I want to just pass this info by him and get his take. The problem with the en-bloc is that it is radical and is therefore more dangerous. It seems like the point is get as many nodes as possible. I know that Olya's husband had an MIE and they were able to get about 30 nodes. I don't necessarily want Jeff to have a radical surgery, but I would like the surgeon to tell me how many nodes he usually takes.

I would be most curious to know how many nodes are taken from long term survivors, I think Williams number would be interesting as he was staged T3N1. I think you should pose the question.

Has your biopsy results been returned already? If not, please think positive thoughts about your PET scan, it could be a false positive. If it has come back as positive I am truly sorry, I know no one wants to hear those words. I just wanted to tell you that I know of another support group that has a gentleman with nodes metastisis, he was clean for five years and one popped up just outside of the radiation field. He has been on xeloda (oral version of 5fu) off and on for two years. He seems pretty upbeat, doesn't complain of side effects. They are managing his disease. I can PM you the address of the group if you'd like. Please don't lose hope, I know it is wise to be realistic, but I think it is also equally important to keep hope alive.

Niki

Niki, I’ll post the node question.
I also want you to know I’m praying and hoping for the best for you and Jeff. Jeff is very fortunate to have someone like you. You’re doing the right thing getting as much info as possible.

I’ll have the biopsy tomorrow and should have the results in 3 to 5 days. Also if you would like to pm me the support group info I would like to take a look.
Thanks,
Joel

swagner

esohpageal cancer
Hi - I was diagnosed with esophageal cancer Sept 2008 (early stage) I was operated on Jan 11, 2010. They removed 26 of my lympnodes. Surgery was at University of Penn in Philadelphia. Not sure if that helps but good luck and i will keep your family in my prayers.

NikiMo

swagner said:

esohpageal cancer
Hi - I was diagnosed with esophageal cancer Sept 2008 (early stage) I was operated on Jan 11, 2010. They removed 26 of my lympnodes. Surgery was at University of Penn in Philadelphia. Not sure if that helps but good luck and i will keep your family in my prayers.

Who at UofP?
Hi Swagner

My husband Jeff received chemo and radiation at UofP. Can I ask who your surgeon was? My husband is having surgery on Tuesday at John Hopkins. Are you from Philadelphia? We have a few folks from this area on the boards now.

Niki
Wife of Jeff T2N1M0