IL vs. MIE

Cora11

So, I've been doing more research and right now we are set to do the IL but we are also talking with Luketich to get more info. And what we are reading from the studies and all the literature is this: Seems that the best benefit of the MIE is that if you are a more frail and older person you might do better with the MIE. Also, that the MIE has shorter hospital stay, shorter ICU stay, less blood loss during surgery, although the OR time is longer. I still can't find out exactly some things that are very important for us to know. If anyone has data I'd appreciate it; How does the node disection compare between the two? Is there a difference in the ability to get good surgical margins ? How about visualizing nodes ? What about anastamoses leaks- are they more common in the IL or the MIE? Also, I read that the most important is that it is very operator dependent- hence go to Luketich. Also, wondering about why the MIE surgery is much longer in time than the IL ? Also seems that when it first came out, they didn't take patients who had chemo/rads before surgery but now they do. Initially they wanted people who were in early diagnosis. My husband is considered kind of inbetween at a t2N0m0. He could likely tolerate an open procedure very well. You hear too that surgeons say there is nothing like a good skilled pair of hands right in there to get the job done vs robot hands. Then again.. you hear they can find nodes better with the wide screen technology. So, back and forth. Well, if anyone wants to chime in with their point of view- and if they have any data or comments from other doctors to support it, I would be very grateful. Thanks so much , as we are really still in the deciding stage.
Cora

chemosmoker

Single out something important....or Just the DR?
Cora,

How about how many people survive for how long after each procedure VS. the other, and also how many have a recurrence with one VS. the other.

That, to me, would seem to outweigh any other information, time in OR, flavor, taste or cost.
Just a thought. I haven't done enough research to know the answers just thinking of this, but I bet someone with a math head HAS.

I have noticed that the best chance on the Earth to survive this cancer seems to be going to see Dr. Luketich, and beyond that, not much else seems to matter. That alone make make my thought mute.

Best wishes and can't wait to hear what you decide, and then GET THERE!!!

God bless you both,
-Eric

jim2011

I would vote MIE
I am a healthy (other than EC) 55yo and have never had surgery before. 5 less than 1" cuts and 2 cuts about 2" and a feeding tube. These cuts were covered with tape and some almost clear stitches that simply went away. The cut on my neck is hidden in a crease in my skin and can hardly notice it anymore.
I did not spend any time in ICU and just 8 days in a regular room. (04/07/2011).
My surgeon was Dr. Eric M. Johnson and his highly skilled team at Abbott in Minneapolis. I am truly a fan of that place!
So anyway, that would be my vote.

flmo

I still feel that MIE is the
I still feel that MIE is the way to go, but of course you have to feel comfortable with your decision. I don't know the answers to your questions,but I would guess that someone on Dr. Luketich's staff (Angela,Chuck,Amy Sue) would have that information. Also,Dr.Luketich just presented a paper on MIE at a conference in Boca Raton in April. You might google his name and you'll find a report on what he stated at the conference. We were told that it was a very prestigions conference with doctors from all over attending. Best of luck with your decision.

Maureen wife of Santo-TlNOMO
MIE UPMC 2/23/2011

BMGky

The IL is quite a surgery!
The IL is quite a surgery! My husband had his some 18 months ago. His last scan showed no evidence of disease. First of all, be satisfied with your surgeon and the facilities and staff. You do want to be where they understand and appreciate esophageal cancer patients. You want a skilled, experienced surgeon who's in the chest weekly. From there, you can decide with his/her advices as to which form is best for your husband. My husband had had previous heart surgery and mesh repair and as such, was not a candidate for the MIE. From those who have had it, it sounds the MIE is the way to go if it is best for your husband. Recovery from the IL has its issues; however, if that is the course you have to choose, it is doable. My husband is back at work fulltime, eating well, etc. I will say the first 6 mos post op were challenging; however, if you keep looking to the future and keep thinking about how fortunate you are to have been eligible to have the operation, all the other issues become insignificant. Best luck to you on your husband's decision. P.S. My husband was not interested in talking to any other surgeon even though I made suggestions. He said he liked his surgeon, had full confidence in him, and wasn't interested in looking elsewhere. I respected his decision. Mary

sammy123

BMGky said:

The IL is quite a surgery!
The IL is quite a surgery! My husband had his some 18 months ago. His last scan showed no evidence of disease. First of all, be satisfied with your surgeon and the facilities and staff. You do want to be where they understand and appreciate esophageal cancer patients. You want a skilled, experienced surgeon who's in the chest weekly. From there, you can decide with his/her advices as to which form is best for your husband. My husband had had previous heart surgery and mesh repair and as such, was not a candidate for the MIE. From those who have had it, it sounds the MIE is the way to go if it is best for your husband. Recovery from the IL has its issues; however, if that is the course you have to choose, it is doable. My husband is back at work fulltime, eating well, etc. I will say the first 6 mos post op were challenging; however, if you keep looking to the future and keep thinking about how fortunate you are to have been eligible to have the operation, all the other issues become insignificant. Best luck to you on your husband's decision. P.S. My husband was not interested in talking to any other surgeon even though I made suggestions. He said he liked his surgeon, had full confidence in him, and wasn't interested in looking elsewhere. I respected his decision. Mary

Cora what I found is that
Cora what I found is that most surgeons who are performing the Ivor Lewis just have not learned the difficult skills needed for the MIE. Once they do that is the way forward. Dr. Luketich pioneered the surgery and is also teaching other physicians how to do it. He has his own floor for just his MIE patients. Less blood loss, lower morbidity, discharged earlier hence less post op problems, good followup, He has done more than anyone in the US possibly the world. Check out William Marshall's bio (patient). He is also a Dr? Luketich fan and talked us into it.

Cora11

BMGky said:

The IL is quite a surgery!
The IL is quite a surgery! My husband had his some 18 months ago. His last scan showed no evidence of disease. First of all, be satisfied with your surgeon and the facilities and staff. You do want to be where they understand and appreciate esophageal cancer patients. You want a skilled, experienced surgeon who's in the chest weekly. From there, you can decide with his/her advices as to which form is best for your husband. My husband had had previous heart surgery and mesh repair and as such, was not a candidate for the MIE. From those who have had it, it sounds the MIE is the way to go if it is best for your husband. Recovery from the IL has its issues; however, if that is the course you have to choose, it is doable. My husband is back at work fulltime, eating well, etc. I will say the first 6 mos post op were challenging; however, if you keep looking to the future and keep thinking about how fortunate you are to have been eligible to have the operation, all the other issues become insignificant. Best luck to you on your husband's decision. P.S. My husband was not interested in talking to any other surgeon even though I made suggestions. He said he liked his surgeon, had full confidence in him, and wasn't interested in looking elsewhere. I respected his decision. Mary

thanks
so much for this input. Greatly appreciated.
Cora

TerryV

Another option - Middle of the Road - THE
Cora

Nick had the THE surgery done just 3 weeks ago today. That was following 28 radiation sessions and 2 weeks of inpatient chemo.

THE is 2 incisions. One about 5 1/2" on the lower left neck, the other from bottom of rib cage to just above the belly button. Nick has had NO problems with either incision.

It is typical for a THE surgery to take 4 - 6 hours; his was 4 1/2. They traditionally take 5 - 15 nodes; they took 7 with him. btw, our surgeon said he doesn't "cherry pick" the nodes. They take what is with the esophageous section they are removing. Margins were clear and his path report came back clean. Nick did not have any time in ICU and was released from hospital 1 week to the day following surgery. His Jtube was removed yesterday (20 days after surgery), and the nurse commented on how well his surgical incisions have closed and healed. Surgery was done here in Iowa at The Stoddard Cancer Center by Dr. Daniel Kollmorgen. Dr. K does not offer MIE.

Are we happy with our results? Hell Yeah!

What was most important to us - other than good results? Comfort With and Confidence In our medical team. We had that in bundles and were rewarded for our faith in them and God.

Terry
Wife to Nick, age 48
dx T3N2M0 05/19/11
THE 09/08/11

sandy1943

I had the IL in May2008. I
I had the IL in May2008. I am still Ned. Knowing what I know now, I beleive I would have chosen the mie. But then my surgeon is a very experienced esophageal doctor and I am so glad I was in his hands. I've never asked him his opinion on the MIE. I don't know if he does it.
I do know the IL is very rough and if it can be done with the MIE , with the same results, then why not.
Sandra

Cora11

sandy1943 said:

I had the IL in May2008. I
I had the IL in May2008. I am still Ned. Knowing what I know now, I beleive I would have chosen the mie. But then my surgeon is a very experienced esophageal doctor and I am so glad I was in his hands. I've never asked him his opinion on the MIE. I don't know if he does it.
I do know the IL is very rough and if it can be done with the MIE , with the same results, then why not.
Sandra

another ?
We are in the process of communication with Pittsburg but I would like to know if anyone has any experience with Dr. Tracey Weigel at UW Madison ?
Cora

sammy123

Cora11 said:

another ?
We are in the process of communication with Pittsburg but I would like to know if anyone has any experience with Dr. Tracey Weigel at UW Madison ?
Cora

follow up
Hello Cora-

I have been thinking of you and your husband. I know what a big decision this is for the both of you. Just so you have a good understanding the MIE is a modified IL. It is the same procedure but done through portals. I will try and find the exact surgical procedure that Dr. Luketich performs so you and your husband can review it especially since you both have such a strong medical background. Just remember it is the same procedure but with a different approach. Once you make a decision don't look back, move forward and proceed accordingly otherwise you will drive yourself crazy. Sounds to me that you have great doctors and you are doing the due diligence necessary. Time (at least to me) is of the essence. This is a very aggressive form of cancer and you can beat it.

http://www.thoracicsurgery.medicine.pitt.edu/content/Minimally_Invasive_Esophagectomy.pdf

Cora11

sammy123 said:

follow up
Hello Cora-

I have been thinking of you and your husband. I know what a big decision this is for the both of you. Just so you have a good understanding the MIE is a modified IL. It is the same procedure but done through portals. I will try and find the exact surgical procedure that Dr. Luketich performs so you and your husband can review it especially since you both have such a strong medical background. Just remember it is the same procedure but with a different approach. Once you make a decision don't look back, move forward and proceed accordingly otherwise you will drive yourself crazy. Sounds to me that you have great doctors and you are doing the due diligence necessary. Time (at least to me) is of the essence. This is a very aggressive form of cancer and you can beat it.

http://www.thoracicsurgery.medicine.pitt.edu/content/Minimally_Invasive_Esophagectomy.pdf

thanks Sammy
Thanks for your input. My husband is still in chemo/ rad so yes... we are being very careful to have surgery scheduled at the right time. I so appreciate all the support here and hope to offer the same to others down the road.
Cora

BMGky

sammy123 said:

Cora what I found is that
Cora what I found is that most surgeons who are performing the Ivor Lewis just have not learned the difficult skills needed for the MIE. Once they do that is the way forward. Dr. Luketich pioneered the surgery and is also teaching other physicians how to do it. He has his own floor for just his MIE patients. Less blood loss, lower morbidity, discharged earlier hence less post op problems, good followup, He has done more than anyone in the US possibly the world. Check out William Marshall's bio (patient). He is also a Dr? Luketich fan and talked us into it.

Just a note. This is not
Just a note. This is not always the case. There are extenuating circumstances that determine the best method for surgery. My husband's surgeon did a post residency fellowship in cancer surgery at Fox Chase Cancer Center in Philadelphia, is skilled in DaVinci robotic surgery, and is well acquainted with current methodology. My husband's Ivor Lewis format was his best choice under his circumstances. Mary

NikiMo

BMGky said:

Just a note. This is not
Just a note. This is not always the case. There are extenuating circumstances that determine the best method for surgery. My husband's surgeon did a post residency fellowship in cancer surgery at Fox Chase Cancer Center in Philadelphia, is skilled in DaVinci robotic surgery, and is well acquainted with current methodology. My husband's Ivor Lewis format was his best choice under his circumstances. Mary

Also note, some patients require the old fashion surgery.
My husband had a previous surgery for a hernia repair, there was a number of adhesions and to quote our surgeon "it was difficult in there". He had to unwrap my husbands stomach from around his esophagus and then try to salvage as much as he could. With all of this he was still able to do this without a leak at the anastomis. Sometimes it is best to have a skilled surgeon that know how to perform the old fashioned IL. My husband doesn't regret having the open procedure, or having it done by one of the best thoracic surgeons in the country, Dr. Yang at John Hopkins. Everyone must come to this decision on their own, just know each patient has their own story. I do not doubt Dr. Ls skills, for MIE he is the best. I know everyone feels very strongly for their surgeon, as do I for my husbands surgeon.

Niki

flmo

sammy123 said:

follow up
Hello Cora-

I have been thinking of you and your husband. I know what a big decision this is for the both of you. Just so you have a good understanding the MIE is a modified IL. It is the same procedure but done through portals. I will try and find the exact surgical procedure that Dr. Luketich performs so you and your husband can review it especially since you both have such a strong medical background. Just remember it is the same procedure but with a different approach. Once you make a decision don't look back, move forward and proceed accordingly otherwise you will drive yourself crazy. Sounds to me that you have great doctors and you are doing the due diligence necessary. Time (at least to me) is of the essence. This is a very aggressive form of cancer and you can beat it.

http://www.thoracicsurgery.medicine.pitt.edu/content/Minimally_Invasive_Esophagectomy.pdf

Everyone's comfort level is different.
I think many doctors don't recommend MIE because they aren't trained in the procedure. Also, it's natural to listen to a doctor that you know and trust. If he doesn't do MIE, of couse he will try to convince you that IL is better. It all boils down to what you are comfortable with. There are no right or wrong answers. When I heard about MIE from William Marshall, I jumped at the opportunity for that procedure for my husband,but some people are more comfortable with the old fashioned method. I do think there are some incorresct statements on this site that say that MIE is reserved for early stage EC patients. That's just not the case.