questions questions

Welcome
Hi Marianne welcome to you and your husband. I was a caregiver for my dad,Ray. He had stage IV EC in 11/08, could not have surgery due to other health issues, so he did 6 weeks of chemo and radiation. This did shrink the tumor, and dad went into remission for a short time. He then found out he had a blocked bile duct in his liver, had a stent put in, found more lesions on his liver, he passed away in March 2010. Now...onto your questions! You will have a whole lot of people responding to you. There are many EC survivors here, who have had this surgery. What the dr is meaning is: Your cousin will have what is called either the Ivor Lewis, or the MIE surgery. One is less recovery time than the other. I think....others will tell you the fact. I do know that what happens in this surgery is the dr will remove the cancerous tumor form his esophagus, and then remove any part of the esophagus that has been damaged. He will then take his stomach and pull it up to meet the esophagus, making your cousin a rebuilt esophagus. Does that make more sense? The feeding tube has to be put in place for awhile until the new esophagus and stomach heal. Like I said actual survivors of this surgery will be talking to you. This is what I have learned in the past 4 years. Your cousin is very lucky to be able to have the surgery. That is a blessing. Stay in touch. We will be here for you always. All you have to do is ask!
Tina in Va

The procedure is called an esophagectomy with gastric pull up
Marianne,

Your cousin is fortunate to be Stage III and a surgical candidate. Many people are not diagnosed with esophageal cancer until they are Stage IV (the cancer has spread to other major organs or distant parts of the body). There are a number of variations of this particular surgery. The three major approaches include:


First the traditional Ivor Lewis (IL) approach. In this approach two large incisions are made. One in the abdomen between the belly button and sternum and one from just under the right shoulder to the middle of the patient’s back. The abdominal incision is used to release the stomach so it can be modified and moved higher to be connected to the remainder of the esophagus. The back incision is used to enter through a space in the ribs to remove a section of the esophagus and form the new connection between the remainder of the esophagus and the remainder of the stomach.

Many surgeons around the US perform this surgical approach.

This approach is the most invasive of the approaches and typically has the longest recovery time. I had this particular surgery and I was in the hospital for 12 days. The original estimate was 10 days but I got an infection in my incisions and was there an extra two days while they gave me IV antibiotics.



Second the Transhiatal Esophagectomy approach. In this approach a large incision is made in the abdomen between the belly button and sternum and a smaller incision is made in the patient’s neck. The abdominal incision is used to perform the same functions as in the IL approach described above. The incision in the neck is used to remove a section of the esophagus and to form a new connection between the remainder of the esophagus and the remainder of the stomach. A more detailed description can be found at

THE Approach

Dr. Mark B. Orringer at University of Michigan Medical Center is a leader in this surgical approach.

The in hospital recovery time for this approach is shorter than the IL approach and the recovery time is somewhat shorter.



Third the Minimally Invasive Esophagectomy (MIE) approach. In this robotically assisted approach a number of very small incisions are made in the abdomen and in the neck. The surgeon uses the robot “arms” and cameras through the small incisions to release and modify the stomach, remove a section of the esophagus and a section of the stomach and re-attach the remainder of the stomach and esophagus. A more detailed description can be found at

MIE Approach

Dr. James D. Luketich at University of Pittsburgh Cancer Institute is the leader in this surgical approach.

The in hospital recovery time for this approach is the shortest of the approaches and the recovery time is shorter as well.


There are a number of reasons why a surgeon may recommend one approach over another. The area around the esophagus has a number of lymph nodes connected into the lining of the esophagus and frequently a number of these are removed to insure a clear surgical margin around the cancer and for pathological examination to validate the staging done prior to surgery. In some cases, prior surgical scar tissue and other medical issues may dictate one approach over the other.

Your cousin should understand his surgeons' reasoning for selecting one approach over the other. “I don’t do that approach” is not the answer he is looking for. This is MAJOR surgery and he wants to have a surgeon that does MANY of these surgeries a year.

When I had my surgery I did not even know an MIE was available. Given my experience, if I had it to do over again I would have traveled to a major cancer center and found a surgeon who is competent in MIE.

Your cousin will have a feeding tube for a while to assist him in getting enough calories while he adjusts to his new digestive system.

Surgery really is his best chance at prolonging his life with this particular cancer.

Hope everything goes well for him

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
Two year survivor

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

Second all the wonderful advice you have recieved...
...this delayed course of treatment seems out of the ordinary. My mom was diagnosed in April of last year 2011) and has already completed chemo, radiation and an MIA. I would definitely start asking further questions. The others have covered these questions in more depth...further health issues, staging, treatment options...etc.

I will also second the welcome to a great group...of supportive and helpful kind hearted survivors.

Best of luck and all my prayers,
Emma