MIE vs Ivor Lewis

Heeran

If you have EC and a candidate for surgery, who decides whether the patient should have MIE or the Ivor Lewis? Do you have to be a special candidate for the MIE? If it's minimally invasive, why wouldn't everyone opt for the MIE? Do you have to qualify?

Heeran, caregiver to my mom just diagnosed with Squamous Cell T3N2M0 Stage 3b

BMGky

MIE is the least invasive
MIE is the least invasive form of an esophagectomy. Healing time is much shorter. Ivor Lewis is the older traditional form. This is the form my husband had.

If the physical condition and diagnosis and staging permit the MIE, and the surgeon is very experienced in performing an MIE and he/she operates at a major cancer center that regularly treats esophageal cancer patients, then that is the way to go.

However, circumstances, medical history can indicate a need for a more invasive procedure.

The key is first the patient's medical status and the second consideration is the skill and experience of the physician.

If your doctor doesn't perform the MIE and you can access a medical facility reasonably that does, definitely I would contact the MIE facility to see if the patient can be a candidate.

Hopefully others will post. I believe the pioneer in MIE is Dr. Luitech in Pennsylvania. From what I've read, he has been contacted by patients and has reviewed (or his staff) their records and helped them plan.

Mr. Marshall who knows so much about the various options available is dealing with the aftermath of the tropical storm and with a health situation facing his mother-in-law.

Hopefully, others can give you more information.

Mary
Husband DX Dec 2009
Thought to be Stage 2B N0M0. Post surgery changed to 2A
Ivor Lewis April 2010
Last PET scan August 2011 NED

NikiMo

Your Mom would make that call
Hi Heeran,

My husband just had surgery this past Tuesday, we decided to have the open procedure and not the MIE. This was because of a previous hernia surgery. I am not defending one surgery over the other, but for my husbands case HE chose to go with the surgeon he felt most comfortable with and the procedure that he thought was the safest for him. Since he had a previous surgery he wanted the surgeon to be able to see the adhesions (scar tissue). Here is what we did regarding surgery. Once Jeff was diagnosed with T2N1M0 we knew that he would have a shot at being a surgical candidate which was confirmed by our oncologist at our initial meeting. Jeff began treatments and we started interviewing surgeons. We met with three surgeons each the Chief of Thoracic surgery at their respective hospitals. One surgeon was an MIE expert, one was a surgeon who performed open THE and IL and did about 40 a year, and a surgeon that did the open THE and IL and did about 100-150 a year. After speaking with all three Jeff made the decision that he wanted the open procedure, and that he FELT most comfortable with the last surgeon. We decided to go with the surgeon at Hopkins the man doing 100-150 a year. Three reasons he was confident, cited a low mortality rate, and is an EC expert. We chose him and he (Dr. Yang) chose which surgery to perform. He did the Ivor Lewis, it was the best choice for my husband.

My point here is that your Mom needs to feel comfortable with her decision. I would suggest speaking with two or three surgeons. Of course there are a few institutions that I know of which are excellent in terms of care provided and surgeons available. In my opinion those are: MD Anderson, Memorial Sloane Kettering, John Hopkins, UPMC, Mayo Clinic, Cleveland Clinic, Moffit, and Mass General. I put those in no apparent order, and I don't want to offend anyone seeking treatment elsewhere, it is just what my research found. Notice I don't have many on the West Coast as we are in Philly and I didn't extend my search out that far. But, I have heard UCLA has an excellent program as well.

Hope this helps,

Niki
Wife of Jeff T2N1M0

BMGky

NikiMo said:

Your Mom would make that call
Hi Heeran,

My husband just had surgery this past Tuesday, we decided to have the open procedure and not the MIE. This was because of a previous hernia surgery. I am not defending one surgery over the other, but for my husbands case HE chose to go with the surgeon he felt most comfortable with and the procedure that he thought was the safest for him. Since he had a previous surgery he wanted the surgeon to be able to see the adhesions (scar tissue). Here is what we did regarding surgery. Once Jeff was diagnosed with T2N1M0 we knew that he would have a shot at being a surgical candidate which was confirmed by our oncologist at our initial meeting. Jeff began treatments and we started interviewing surgeons. We met with three surgeons each the Chief of Thoracic surgery at their respective hospitals. One surgeon was an MIE expert, one was a surgeon who performed open THE and IL and did about 40 a year, and a surgeon that did the open THE and IL and did about 100-150 a year. After speaking with all three Jeff made the decision that he wanted the open procedure, and that he FELT most comfortable with the last surgeon. We decided to go with the surgeon at Hopkins the man doing 100-150 a year. Three reasons he was confident, cited a low mortality rate, and is an EC expert. We chose him and he (Dr. Yang) chose which surgery to perform. He did the Ivor Lewis, it was the best choice for my husband.

My point here is that your Mom needs to feel comfortable with her decision. I would suggest speaking with two or three surgeons. Of course there are a few institutions that I know of which are excellent in terms of care provided and surgeons available. In my opinion those are: MD Anderson, Memorial Sloane Kettering, John Hopkins, UPMC, Mayo Clinic, Cleveland Clinic, Moffit, and Mass General. I put those in no apparent order, and I don't want to offend anyone seeking treatment elsewhere, it is just what my research found. Notice I don't have many on the West Coast as we are in Philly and I didn't extend my search out that far. But, I have heard UCLA has an excellent program as well.

Hope this helps,

Niki
Wife of Jeff T2N1M0

Very good information and
Very good information and advice. I guess that is the reason my husband had the IL. He had had heart surgery and subsequent incision hernia repair with mesh in the chest. The surgeon felt he needed to access the entire chest area. He did a great job and are pleased with how my husband is doing. You are right. The ultimate decision comes down to the EC patient being comfortable with the decisions made.

Heeran

BMGky said:

Very good information and
Very good information and advice. I guess that is the reason my husband had the IL. He had had heart surgery and subsequent incision hernia repair with mesh in the chest. The surgeon felt he needed to access the entire chest area. He did a great job and are pleased with how my husband is doing. You are right. The ultimate decision comes down to the EC patient being comfortable with the decisions made.

Thank you all
Thank you all for your input. My mother is terrified of surgeries of any kind. A week ago, she even said, "if they tell me to have surgery, I won't have it" She has since changed her tune but I know she would be deathly afraid of the Ivor Lewis. There's a doctor here in town who performs 40-50 a year. I know that's considered high volume but seeing all the posts, I think I'll also contact Dr. Luketich's office as well. I just thought maybe the travel would be hard on her. My mom really relies on me to help make the decisions for care for her. I just don't want to mess up by selecting wrong choices.

flmo

Heeran said:

Thank you all
Thank you all for your input. My mother is terrified of surgeries of any kind. A week ago, she even said, "if they tell me to have surgery, I won't have it" She has since changed her tune but I know she would be deathly afraid of the Ivor Lewis. There's a doctor here in town who performs 40-50 a year. I know that's considered high volume but seeing all the posts, I think I'll also contact Dr. Luketich's office as well. I just thought maybe the travel would be hard on her. My mom really relies on me to help make the decisions for care for her. I just don't want to mess up by selecting wrong choices.

MIE
If your mother is really terrified of surgery, I would think the MIE would be the way to go, if feasible. The recovery time is SO much faster. Most cardiothoracic surgeons aren't trained in the MIE technique. That's why it's so important to find one who has done many and has a really good mortality rate like Dr. Luketich. He and his staff are wonderful!

Best of luck as you help make the decision for your mother.

paul61

It is possible you could find an MIE surgeon in your area
Heeran,

I know sometimes travel itself can be an issue. I would encourage you to contact Dr. Luketich's office and ask if they can recommend a surgeon that has been trained by him that is closer to your area. I know there are members of the group here who have had MIE surgery, by surgeons in other parts of the United States, who have trained with Dr Luketich.


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
3/14/2011 CT Scan NED

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

JimboC

I had to seek out an MIE.
I had to seek out an MIE. When I asked my first surgeon, he said I was not a candidate due to my size. At the time I weighed 245 at 5'7". After researching everything here and talking with the Marshall's, I talked to Dr. Luketich's team in Pittsburgh and they felt I was a good candidate for the MIE. that was performed on July 1st and I'm doing great now. Long story short, don't be afraid to search out the treatment you want.