Answer 4 "KBdarnall"~Dr. Ninh Nguyen-UCIrvine-excellent Thoracic Surgeon SPECIALTY-Ivor Lewis Minima
(Note: Let me apologize for putting an entry here that is running off the right side of the margin. I don't know how to fix it and hope it doesn't happen again. So if you will move the bottom bar all the way to the right, the entire text will be visible. Sorry - Loretta) Now on with the really important information.
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Dear “Kb”
Since you are not the first person to not know what to do when your husband has been diagnosed with Esophageal Cancer, I decided to put this on a separate topic forum for this reason. There is an excellent thoracic surgeon named Dr. Ninh Nguyen that operates out of UCIrvine in California. By the map, I see that it is only an hour from your house. If you want to have an excellent SECOND OPINION, I can offer no better thoracic surgeon on the West Coast. I happen to live on the East Coast and my husband went to the University of Pittsburgh Medical Center. His Ivor Lewis Minimally Invasive Esophagectomy (MIE) was performed by Dr. James D. Luketich. You will note that Dr. Nguyen studied with Dr. Luketich (the pioneer of the MIE) in the mid-90s. Many surgeons now come to learn the technique of the laparoscopic Ivor Lewis Minimally Invasive from Dr. Nguyen who is now a professor in his own right. You should be impressed with all the publications that he has written that have been published by peer reviewed journals.
Since there are others reading here on a regular basis that would like to know more about the MIE, I am putting your last posting here, and my answers to you. I feel that this is the most I can do to help you make a decision. So here is your last letter although we have spoken before this one. You will see my remarks and my references underneath this letter. As usual, this is quite lengthy! [Loretta]
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“https://csn.cancer.org/comment/1614791#comment-1614791
Thank you for posting details regarding "choice"
Did the surgeon really say your father's cancer would return in 3-12 months if no surgery?
My husband's radiation oncologist suggested no-surgery-option might be reasonable in his case. I am trying to gather information ASAP. He is 71 years old, Stage IIb, T3N0M0. 5 cm mass is at the GEJ. Husband is half done with chemoradiation therapy, He gets Carbo/Taxol weekly and (probably) 28 radiation treatments. Radiation doctor said he might "boost" dosage near the end and possibly add a few more treatments. This depends on Husband's ability to tolerate treatment and whether he really wants to decline surgery.
Yesterday, we had an extra consultation with GI doctor who performed the endoscopic ultrasound. Because the mass was so large, he was "very lucky" there were no enlarged lymph nodes. CT-PET was also negative for metastatic cancer. GI doctor suggested: Radiologists tend to overestimate value of their specialty. Surgeons do the same. A surgeon is not likely to recommend no-surgery-option if the patient is clearly a candidate for "curative" resection. We should place highest value on infusion oncologist's opinion. However, a 2nd opinion from a surgeon (not doing the surgery) would be wise.
GI doctor would not perform another endoscopy BEFORE neoadjuvant therapy is done because it probably wouldn't help. The surface of the esophageal junction will have scar tissue from radiation treatment. Cancer cells could be buried deep within the scar tissue. A thoracic surgeon ordinarily performs endoscopy (immediately before surgery) to evaluate the esophagus from the inside.
Right now, we are focused on finishing treatment, maintaining good diet and exercise. The next few weeks will go quickly. We live near Los Angeles. There's more than a few good hospitals and surgeons within driving distance. I may try UCLA. Current surgeon is at Cedars Sinai.
A few days ago, I asked the infusion oncologist to estimate Husband's chance of 5-year survival. He answered roughly 60% without surgery and 75% if he gets surgery. Perhaps this is wild speculation. But the doctor did his best to respond truthfully. Certainly he will have a better chance for long-term survival with surgery. But there is COST in terms of quality of life. The question: How much advantage? This is an unanswerable question.
I will post more, as I learn more. “
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My answer here:
Dear “Kb”
With your husband’s diagnosis, come Hell or High Water, I would have the surgery. My husband had no reduction in quality of life after his Ivor Lewis Minimally Invasive Esophagectomy performed by Dr. James D. Luketich back on May 17, 2003. The only change that is “permanent” is sleeping elevated to keep the acid that is still produced in the stomach from backing up to his throat and causing bad heartburn and acid reflux. My husband was diagnosed in November of 2002 with Stage III (T3N1M0) meaning that he had all four walls of his Esophagus infiltrated by the tumor and also two lymph nodes showed positive for cancer. My husband’s quality of life did NOT decrease after his MIE. There is a process of adjusting to a new way of eating, but that gets back to normal within the first year. My husband’s energy level was back to normal in no more than 5 months. I have to share his story to offset the many tragic stories that you might read here.
My soul, you say that your husband’s PET/CT scan shows no metastasis—how much can you ask for. That’s fantastic. Fifteen years we are still enjoying each other’s presence and knowing what we know now, we want everyone that is a surgical candidate to “go for it.” You will never be able to figure out the future by comparing other’s experiences, but you are selling your marriage short in my view if you try to figure out the odds. That’s impossible. There is scar tissue that builds up with repeated radiation (my husband had 25 treatments) so Dr. Luketich likes to do the surgery as soon as possible after the completion of treatments. However, my husband’s PET/CT scan wasn’t done until 3 weeks after the last treatment because chemotherapy has a residual effect of 3 weeks after the last treatment. So by that time an accurate assessment can be made. Then surgery is in no more than 3 weeks after the last scan.
When we first visited the oncologist and asked him how long my husband might live if we didn’t do the chemotherapy. We were so naïve, we thought we would just skip the pre-op chemo/radiation bit and go straight to the surgery. That’s how dumb we were. Not with a Stage III diagnosis, but we’re pretty fast learners, so it only took about 10 days of prayer to make the right decision.
Our oncologist said, “Possibly 18 months.” Well I think he was being overly optimistic knowing what I know now. Our surgeon said, even if the PET/CT scan conducted at the completion of the neo-adjuvant chemo/radiation series proves to be 100% eradicated, surgery must still be done to insure that there is nothing “hidden” that was not picked up by the scan. We totally agreed with that. And we are so happy that we did what the doctor said. 22 lymph nodes were removed for pathology during the operation, and thank God none of them showed metastasis. We couldn’t be happier. I cannot help but share our story because I know that others can have the same positive outcome as did we.
If I were you, I would have a totally new second opinion and not talk to members of the same group. There is a wonderful thoracic surgeon named Dr. Ninh Nguyen that operates out of UCIrvine in California and it is only 42 miles from Los Angeles. It’s only an hour from your house. Dr. Nguyen is an excellent thoracic surgeon who interned with Dr. James D. Luketich, the pioneer of the Ivor Lewis Minimally Invasive Esophagectomy, back in the mid-90s at the University of Pittsburgh Medical Center (UPMC). He has written hundreds of articles relative to Esophageal Cancer that have been peer reviewed and published by top medical journals.
So I will give you his vitals below my name. If I lived in California, I would certainly go see him. Please see his video as he performs an esophagectomy on one of his patients. It is of course in excerpts and is quite long but well worth watching and listening to his comments along the way. I would put it in "full screen mode" to watch. You should watch it in its entirety. It’s not scary. If you want to see “scary” try watching an “Open” Ivor Lewis surgery…..Egads!
So I can tell that you are tortured and totally not knowing what to do. You are vacillating between surgery and no surgery, although by all you have written, your husband is a candidate for an Esophagectomy. You cannot figure out the future before the surgery, but you can figure out the future if you do not have it. So I would take my chances on living if I were you.
As sincere as I know how to be,
Loretta (William’s wife) Diagnosed EC Stage III (T3N1M0), November of 2002 @ age 65 - chemo/radiation then MIE @ UPMC by Dr. James D. Luketich on May 17, 2003. My husband is still cancer-free as of this date, January 27, 2018. He will be 81 on February 12th. He had no complications and we are blessed. This could be your story as well. Take a chance on LIFE!
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2. http://www.ucirvinehealth.org/find-a-doctor/n/ninh-nguyen
Ninh T. Nguyen, MD
Specialties
Surgery
Clinical Interests
Laparoscopic antireflux surgery, Laparoscopic esophagectomy, Laparoscopic gastrectomy, Laparoscopic gastric bypass, Laparoscopic Heller myotomy, Laparoscopic gastric banding, Laparoscopic Roux-en-Y gastric bypass, Laparoscopic hiatal hernia repair
University of Texas - San Antonio
Internship
Mount Sinai Hospital of Greater MiamiGeneral Surgery
Residency
Mount Sinai Hospital of Greater MiamiGeneral Surgery
Fellowship
University of Pittsburgh School of MedicineSurgical Oncology
University of Pittsburgh School of MedicineLaparoscopy
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Ninh T. Nguyen, MD
Specialties
Surgery
Clinical Interests
Laparoscopic antireflux surgery, Laparoscopic esophagectomy, Laparoscopic gastrectomy, Laparoscopic gastric bypass, Laparoscopic Heller myotomy, Laparoscopic gastric banding, Laparoscopic Roux-en-Y gastric bypass, Laparoscopic hiatal hernia repair
Professional Positions
- Interim chair — Department of Surgery
- Chief — Division of Gastrointestinal Surgery
- Professor — Department of Surgery, UC Irvine School of Medicine
- Vice-chair — Department of Surgery
- Past president — American Society for Metabolic and Bariatric Surgery
Awards and Recognition
- America's Top Doctors (Gastrointestinal Cancer, Laparoscopic Surgery, Obesity/Bariatric Surgery), Castle Connolly Medical Ltd., 2013
- Best Doctors in America® (Surgery), 2011-2013
- Physicians of Excellence, Orange County Medical Association — 2013-2018
- Golden Scope Award, Society of American Gastrointestinal & Endoscopic Surgeons (SAGES), 2002
More Information
Dr. Ninh T. Nguyen is a board-certified UC Irvine Health surgeon who specializes in minimally invasive gastroesophageal surgery and bariatric surgery. He pioneered the development of laparoscopic esophagectomy and gastrectomy for the treatment of esophagogastric pathology and laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity.
Nguyen is a member of the American College of Surgeons, the Association for Academic Surgery, the American Society for Metabolic and Bariatric Surgery (ASMBS), the Society for Surgery of the Alimentary Tract, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American Surgical Association. In 2002, he received the Golden Scope Young Researcher Award from SAGES, in recognition of significant contribution to research in laparoscopic surgery.
He is also past president of the ASMBS and serves as the ASMBS representative on the Gastrointestinal Surgery Advisory Council for the American Board of Surgery. He is currently the president of the North American Chapter of the International Federation for the Surgery of Obesity and is on the editorial board for Journal of the American College of Surgeons, Surgical Endoscopy and Annals of Surgery. He has been the principal investigator on numerous research grants and has published more than 250 peer-reviewed articles and book chapters.
Nguyen earned his medical degree from the University of Texas Health Science Center at San Antonio, Tex. He completed a residency in general surgery at Mount Sinai Medical Center, Miami Beach, Fla, followed by fellowships in surgical oncology and minimally invasive surgery at the University of Pittsburgh Medical Center, Pittsburgh, Penn.
Speakers Bureau Topics
- Anti-Reflux Operation
- Bariatric Surgery
- Esophageal Cancer
- Gastric Cancer
- Laparoscopic Cholecystectomy
- Laparoscopic Surgery
- Hiatal Hernia
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4. https://www.faculty.uci.edu/profile.cfm?faculty_id=5621
[My note: This gives you an idea of how smart Dr. Ninh Nguyen is. This reference includes over 200 of his publications plus excerpts from books that are too lengthy to copy here, but you can read over them below this information. He is one of the “cream of the crop” of thoracic surgeons.]
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“Ninh Tuan Nguyen Interim Chair, Surgery Chief of Gastrointestinal Division, Surgery Professor, Surgery |
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Research |
Esophageal cancer, Gastric cancer, Esophageal reflux disease, Morbid obesity, Bariatric surgery |
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Academic |
1986 Outstanding Senior Student majoring in chemistry, American Institute of Chemists |
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Appointments |
1997-1998 Clinical Instructor of Surgery _____________________________________________________
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5. https://nortonsafe.search.ask.com/search?chn=1000820&ctype=videos&doi=2016-09-30&geo=US&guid=333950C0-F332-49D9-8207-443FE0C2AF63&locale=en_US&o=APN11910&p2=^EQ^ch20us^&page=1&prt=NSBU&q=videos+by+dr.+ninh+nguyen+minimally+invasive+esophagectomy&tpr=sbt&ver=22.8.0.50&vidOrd=2&vidId=u3o30epRTiM
“Sep 19, 2016 | 892 views | by Julie Gonzalez
DUE TO THE GRAPHIC NATURE OF THIS VIDEO, VIEWER DISCRETION IS ADVISED. Minimally Invasive Esophagectomy featuring Ninh T. Nguyen, MD, . Minimally Invasive Esophagectomy with two fields lymphadec...
[My note: This is a 1hr. and 26 minute video. Anyone wanting to know what is involved in an Ivor Lewis Minimally Invasive Esophagectomy. (MIE) When he is talking about where the cancer begins, it is always measured from the “incisor” (teeth) downward.]
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6. https://www.healthline.com/human-body-maps/esophagus
[My note: As you move the lever up and down on the right side, you will see the different layers of the chest how the Esophagus is positioned in that space.]
Esophagus
The esophagus is a hollow muscular tube that transports saliva, liquids, and foods from the mouth to the stomach. When the patient is upright, the esophagus is usually between 25 to 30 centimeters in length, while its width averages 1.5 to 2 cm.
The muscular layers that form the esophagus are closed tightly at both ends by sphincter muscles, to prevent food or liquids from leaking from the stomach back into the esophagus or mouth. When the patient swallows, the sphincters temporarily relax to allow passage of the food through.
The esophagus passes close to the trachea (breathing tube) and the left side of the heart. This means that problems with the esophagus, such as eating something too hot, can sometimes feel like a pain close to or in the heart or throat.
Like any other part of the body, the esophagus can be damaged. Heartburn and cancer are both problems affecting the esophagus. The most common problem is gastroesophageal reflux disease (GERD), when the sphincter at the base of the esophagus does not close properly, allowing stomach contents to leak back into the esophagus and irritate or damage it over time. With prolonged GERD, esophageal ulcer is likely to occur.
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7. https://www.healthline.com/human-body-maps/digestive-system
The digestive tract begins this involuntary process once food is consumed. Saliva begins the breakdown of food, and other enzymes in the digestive tract extend this process. As digestion continues, the food is propelled from organ to organ through muscular contractions called peristalsis.
The largest parts of the digestive system include:
- Esophagus: A hollow tubular organ in the neck and chest area that connects the mouth to the stomach. Muscles here propel food to the stomach.
- Stomach: A large organ that holds and digests food through a cocktail of enzymes and acids. Food remains here for two to eight hours.
- Liver: This organ helps filter toxins from the blood and produces bile, which helps break down proteins, carbohydrates, and fats.
- Gallbladder: This sac-like organ stores bile produced by the liver and then releases it as necessary.
- Pancreas: This organ produces insulin, which aids in the metabolism of sugars.
- Small intestine: The small intestine receives food from the stomach and begins to break down the food while absorbing the majority of its nutrients.
- Large intestine: This organ is filled with billions of harmless bacteria that turn food into feces while removing water and electrolytes for the body’s use.
- Rectum: At the end of the large intestine, this small space is a temporary storage area for feces.
- Anus: This is the external opening of the rectum, through which feces are expelled.
The connection between all of these organs and their fluids requires a delicate balance that can easily be disrupted by numerous factors, including diet, stress, disease, and more…”
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8. http://www.gomn.com/news/mayo-clinic-says-get-a-second-opinion-first-ones-are-frequently-wrong/
“MAYO CLINIC SAYS GET A SECOND OPINION – FIRST ONES ARE FREQUENTLY WRONG…”
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9. https://www.travelmath.com/drive-distance/from/Irvine,+CA/to/Los+Angeles,+CA
The driving distance from Irvine, California to Los Angeles, California is:
41 miles / 66 km
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