Surgery in New York

Sue Ellen

Does anyone have any experience with surgerons in New York for Esophagectomy?  

LorettaMarshall

Sue Ellen~More info than U asked 4~hope it will B helpful!

Hello Sue Ellen,

Are you familiar with the USNews Health report that ranks all hospitals according to their specialties? The link below will give the 50 best hospitals for the treatment of Gastroenterology and GI Series.  This is the category under which “Esophageal Cancer” is ranked. 

For instance, many MDAnderson & Cancer Treatment Centers of America must be among the top hospitals for cancer PERIOD—end of discussion!  WRONG!  Actually Mayo Clinic in Rochester, MN is ranked #1 for Gastroenterology & GI Surgeries.  So while I don’t personally have a recommendation, I do trust these rankings.  Of course, some people might have to go to a hospital within their “network” and that might preclude their going just anywhere they would really like to go.  But please check out these rankings as pertains to Esophageal Cancer. 

As always, I have to brag on my husband’s thoracic surgeon, Dr. James D. Luketich, who pioneered the Ivor Lewis Minimally Invasive Esophagectomy aka MIE.  This surgery is totally laparoscopic.  Furthermore, by now I’m sure UPMC will soon be reaching the 2,000 mark for the MIE as noted in the remarks by Dr. Luketich in a video which I've included below.  My husband was included in the first 1000 patients to have the MIE, and that summary of patients’ treatments was published back in 2010.  Dr. Luketich operates out of the University of Pittsburgh Medical Center.  And while everyone will not necessarily be able to go there, I think the next best thing would be to choose from some hospital that ranks near the top.  UPMC ranks #6. 

From this list,

1.       https://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery

I note that Mt. Sinai is ranked #8 in the field of Gastroenterology & GI Surgeries.  This is the first hospital that I see “ranked” that is located in New York.  Of course, I would want to thoroughly review the credentials of the thoracic surgeons there.  Now having said all that, I note that Mt. Sinai seems to perform the Transhiatal Esophagectomy (THE) that involves an 2 incisions and one incision is in the neck.  It is more invasive than the Ivor Lewis MIE performed by Dr. Luketich.  Dr. Luketich makes a very small incision in the right side of the chest, and not in the neck.  This reduces greatly the possibility of damage to the pharyngeal (throat) and laryngeal (voice) nerves that are there.  So I would certainly want to ask many questions of the thoracic surgeon you might select there, or any hospital you decide to go to.  There are 3 main types of Esophagectomies, the Ivor Lewis Esophagectomy (TTE) and the most invasive also called the OPEN surgery, because it is surely that requiring two very large incisions.

Then there is the “Transhiatal” (THE) that is less invasive than the OPEN.  Nevertheless, the third and least invasive is the Ivor Lewis Minimally Invasive Esophagectomy (MIE).  But since you didn’t ask all that, you may already have all the information you need to know.  But for the time being, I will give you a link to the Transhiatal Esophagectomy since that is the one I see written about in Mt. Sinai’s page, and also a MIE video by Dr. Ninh Nguyen who performs the totally laparoscopic Esophagectomy. 

I would certainly want to research the credentials of the thoracic surgeon. There are lots of questions one should ask, after they have first sought out an excellent hospital that specializes in their particular disease—in your case that would be Esophageal Cancer.  I hope this information helps and if there is anything we can help with, let us know.  Between the ones that regularly post here, I’m confident you will receive much helpful information.

• ·         How many Esophagectomies has he performed during a year?
• ·         What type of Esophagectomy have they been trained to perform?
• ·         What kind of training does he/she have?
• ·         Have they written all or part of any journals relative to Esophageal Cancer that have been peer reviewed and published in major medical journals?
• ·         How long have they been performing the Esophagectomy?
• ·         What is their mortality rate? The leak rate?

In other words, the patient who has the cancer, should conduct their own research before blindly accepting just any thoracic surgeon.  All surgeons did NOT graduate at the top of their class! 

I would certainly seek a SECOND opinion, as this is major-major surgery, but there are survivors—so remember that.

May I say, “Happy Thanksgiving” as it is now Thursday, November 23, 2017.  Even though many of us are “sick” with something, I for one, am happy to still be alive and able to have one more Thanksgiving meal with my family.  God bless the USA!

Loretta (Wife of William, DX Adenocarcinoma @ the GE Junction Nov. of 2002, (T3N1M0), neoadjuvant chemo/radiation, then MIE at UPMC on Saturday, May 17, 2003, by Dr. James D. Luketich.  Thank God my husband is now into Year 15 with no recurrence. 

______________________________________________________________ 

Here is that specific link for Mt. Sinai

2.       https://health.usnews.com/best-hospitals/area/ny/mount-sinai-medical-center-6213140

This Hospital's Performance

Adult Specialties Rankings and Ratings

U.S. News evaluates each hospital in up to 16 medical specialties. In most specialties, the top 50 hospitals nationally are numerically ranked. Hospitals that nearly made the top 50 may be recognized as high performing.

Specialty	National Rank	Overall Score
Cancer	#44	62.4/100	Scorecard
Cardiology & Heart Surgery	#  9	75.1/100	Scorecard
Diabetes & Endocrinology	#19	70.9/100	Scorecard
Gastroenterology & GI Surgery	#  8	75.3/100	Scorecard
Geriatrics	#  3	94.3/100	Scorecard
Gynecology	#23	77.1/100	Scorecard
Nephrology	#10	82.0/100	Scorecard
Neurology & Neurosurgery	#16	71.3/100	Scorecard
Orthopedics	#44	57.0/100	Scorecard
Urology	#48	69.4/100	Scorecard
Psychiatry	High Performing	3.4/100	Scorecard
Pulmonology	High Performing	67.9/100	Scorecard
Ear, Nose & Throat	Not Ranked	60.1/100	Scorecard
Rehabilitation	Not Ranked	2.5/100	Scorecard

_______________________________________________________________ 

3.      http://www.mountsinai.org/patient-care/service-areas/surgery/divisions/surgical-oncology/cancers-we-treat/esophageal-cancer

“Esophageal Cancer Treatment and Surgery

Our surgeons work closely with our colleagues in the Gastroenterology Department to provide the best care for patients with esophageal cancers.

The first step in treatment of esophageal cancer is a careful assessment of the tumor stage. We employ a range of diagnostics including PET scans, endoscopic ultrasound, and lymph node sampling to correctly determine the cancer stage. We then collaborate with experts in Medical Oncology and Radiation Oncology to create the best treatment plan for each patient. Depending on the type and stage of cancer, options may include surgery alone, or in combination with other treatment modalities.

Types of surgical procedures for patients with esophageal cancer include:

• Total gastrectomy with esophagojejunostomy: For esophageal tumors that are actually extensions of gastric cancer, surgeons perform a resection of the stomach together with the involved esophagus. The surgeons then recreate the connection to the small bowel to allow normal food intake.
•  
• Ivor Lewis esophagectomy: This procedure combines an abdominal approach as well as a thoracic approach to remove tumors that are located in the mid-esophagus.
•  
• Laparoscopic transhiatal esophagectomy: This procedure uses minimally invasive techniques to resect the esophagus, and an incision in the neck is made to recreate the connection to the stomach.”

_________________________________________________________________________ 

4.      http://www.upmc.com/Video/Pages/default.aspx?vcat=937%3b%233753ef4c-73b8-4be7-b0c7-9c5fd91b952c%7cLung+and+Thoracic+Surgery

 [My note:  Choose the video that shows Dr. Luketich speaking.  This a 2:52 min. video.  In short he explains the benefits of the very least invasive Esophagectomy and that is the MIE.]

___________________________________________________________ 

5.       https://www.youtube.com/watch?v=oItauetshNQ

 [My note:  This “hand assisted Transhiatal Esophagectomy” requires 2 incisions—not band aid cuts as with the MIE.  The MIE that Dr. Luketich performs ]carries with it the shortest hospital stays and quickest recoveries with the least blood loss and less chance of infections.]

Laparoscopic Transhiatal Esophagectomy - Medtronic Minimally Invasive Therapies Group - Published on May 4, 2011

DUE TO THE GRAPHIC NATURE OF THIS VIDEO, VIEWER DISCRETION IS ADVISED. Laparoscopic Transhiatal Esophagectomy featuring Mary S. Maish, MD, Assistant Professor of Surgery, Division of Thoracic Surgery, David Geffen School of Medicine, UCLA, Director, UCLA Center for Esophageal Disorders (SDMK13CD0800258)

__________________________________________________________________  

 6.      https://www.youtube.com/watch?v=hx4hS21AbuI

 [My note:] This is Dr. Ninh Nguyen who operates out of UCIrvine in California.  He interned with Dr. Luketich back in the mid-90s and performs the totally laparoscopic MIE with the chest incision as Dr. Luketich speaks about.  Listen carefully to Dr. Nguyen’s comments as he walks through different aspects of this Ivor Lewis Minimally Invasive Esophagectomy.  This is not as graphic as watching the “hands-assisted Transhiatal”]

 “Minimally Invasive Esophagectomy - Medtronic Minimally Invasive Therapies Group - Published on May 4, 2011

DUE TO THE GRAPHIC NATURE OF THIS VIDEO, VIEWER DISCRETION IS ADVISED.

Minimally Invasive Esophagectomy featuring Ninh T. Nguyen, MD, Professor of Surgery Chief, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center (SDMK13CD0800259)”

___________________________End of references______________________________