Upcoming Surgery

Louise L
Louise L Member Posts: 6
in Esophageal Cancer #1

Hi my name is Louise and this will be my first post.  I have been reading many posts on here for the last couple of months ever since my dad was diagnosed with Esophageal Cancer back on July 18, 2014.  My dad has just finished his 5 weeks of treatment Chemotherapy and Radiation and is set for surgery this coming Thursday November 20.  I know he is absolutely terrified and so are rest of us.  On his last Endoscopy which was performed 2  days ago, there is no evidence of the Tumor, which is great news and means that the Chemo and Radiation were successfull.  So here is the question,  Due to the fact that there are so many complications with the Surgery, should he have it??  Unfortunately I was unable to attend the meeting with the Surgeon with my parents and I Know they are scared and unsure.  One thing which I was unaware of was that during the Surgery they have to break or fracture 2 of the ribs and deflate the one Lung to get at the part of the esophagus that they want to remove.  This Surgery seems very complex and serious, any advice or suggestions would be greatly appreciated.

Thanks Louise L

Comments

  • South Side Steve
    South Side Steve Member Posts: 32
    #2
    Been There, Done That

     

    Hi Louise,  

     

    I understand your dad’s concerns; I was in the same situation 2-1/2 years ago. I know I spent more than a few sleepless nights trying to decide if I should have the surgery or not. I kept thinking about how everyone talked about this being a “life-changing” surgery. I finally decided to go ahead with the surgery because I wanted to do everything possible to prevent this cancer from recurring. I don’t regret my decision one bit. It is a major surgery and it takes a very long time to recover, but I’m pretty much back to doing everything I did before the surgery. I was in the hospital for 10 days and went back to work at a desk job 4 months after surgery. Realistically, I should have waited another month before going back to work, but I was going stir crazy at home. I was very fortunate and didn’t experience a lot of the post-surgery complications that a lot of others do. I never used my feeding tube after being released from the hospital and have not needed any dilations or stretching of my esophagus. The only major lifestyle change is sleeping in an elevated position. I did suffer a fractured rib during surgery and that took a long time to heal. I was 61 when I had the surgery and didn’t have any other health issues.

      

    I know exactly what your dad is going through. It helped me to talk to persons that had gone through the journey, so I would be willing to talk to you or your dad about my experience. Just send me a message on this site and I will give you my contact information. Good luck to your dad in whatever decision he makes.

      

    Steve  

    DX T2N1M0 Stage IIB on 11/3/2011, Ivor Lewis surgery on 3/13/2012

     

  • paul61
    paul61 Member Posts: 1,392 Member
    #3
    The surgery you are describing is an Ivor Lewis approach

    Louise,

     It sounds like the surgical approach that you are describing is the traditional “Ivor Lewis” approach to an esophagectomy with gastric pull up. There are other less invasive surgical approaches.

     As to your first question, “Should my Dad go ahead with the surgery?” Surgery is the best way to insure that all the malignant cells are removed. In the close to five years since I have been following EC on various forums, I have seen numerous cases where patients have elected not to have surgery and had a recurrence. Even though the CT and PET scans showed no remaining tumor activity after radiation and chemotherapy, active cells were found under the scar tissue in the area of the tumor when the esophagus was surgically removed and analyzed in pathology later.

    Surgery is the best way to give your Dad the best chance at a “cancer free” future.

     If your Dad elects surgery please be aware are multiple surgical approaches to an esophagectomy with gastric pull up.

    The 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. Frequently ribs need to be altered and one lung collapsed to allow entry to the surgical field in this approach.

    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

    http://surgery.med.umich.edu/thoracic/clinical/what_we_do/esophagectomy_faq.shtml

     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 http://www.upmc.com/media/NewsReleases/2000/Pages/minimally-invasive-approach-esophagectomy-lower-morbidity-quicken-return-daily-activity-upmc-surgeons-report.aspx

    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.

    Be sure you understand your surgeons reasoning for selecting one approach over the other. “I don’t do that approach” is not the answer you are looking for. This is MAJOR surgery and you want 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.

    Of course you need to be comfortable with your surgeon and insurance is sometimes an issue. But I wanted to you be aware that there are choices and you should make an informed decision.

    Best Regards,

    Paul Adams

    McCormick, South Carolina
    DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009
    Cisplatin, Epirubicin, 5 FU - Four Year Survivor

     

  • Deathorglory
    Deathorglory Member Posts: 364 Member
    #4
    Some Thoughts

    Hello Louise,

    I have a couple of things that may provide you some fuel for thought.  For where you guys are in this journey, my situation was about identical.  I had chemo/radiation (with no residual signs of cancer), then surgery, then a bonus round of chemo.  The surgery was sold to me as the best chance of warding off a recurrence as was the bonus round of chemo.  Later, I had a recurrence in a lung.  Although the surgery didn't produce results as hoped, I'd still do it the same way again.  This is a serious disease.  It requires serious methods to combat it successfully.  I will tell you that concerns about the surgery are fair.  This is a BIG DEAL surgery, frequently accompanied by serious side effects.  For example, I wound up with pneumonia, which is unpleasant and life threatening.  Another thing to consider is your father's overall condition besides the cancer.  While I would go for the surgery again in a second, I was 41 and fairly strong.  If your father is 96 and frail, you may think differrently than I did.  

     

    However you guys decide to approach this, please concern yourselves most with your father's wishes and preferences.  Ultimately, he's the one who has to live with the results.

     

    All the Best,

     

    Ed

  • Louise L
    Louise L Member Posts: 6
    #5
    I want to thank all those who

    I want to thank all those who responded, very much apprecitated.  Looks like my dad has decided to go for the Surgery knowing that this is his best possible chance to be cancer free.  I have told my Dad about this forum that I am on, letting him know that anytime he would like to chat with others who have gone down the same journey might help him with any questions or concerns that he may have.   Until then I will keep you posted, Surgery booked for this Thursday.

     

    Many Thanks

    Louise L

  • Louise L
    Louise L Member Posts: 6
    #6
    Eating Issues

    Dad had Surgery on November 20,  Everything went well was in hospital for 2 weeks and just came home yesterday. Dad also had part of his colon removed as cancer was found there from a previous CT scan. so he is dealing with 2 surgeries in one.  Pathology results came back and he is NED which is great news.  The problem is that food is going right thru him, any advice would be great.

     

    Thanks Louise L

  • Deathorglory
    Deathorglory Member Posts: 364 Member
    #7
    Louise L said:

    Eating Issues

    Dad had Surgery on November 20,  Everything went well was in hospital for 2 weeks and just came home yesterday. Dad also had part of his colon removed as cancer was found there from a previous CT scan. so he is dealing with 2 surgeries in one.  Pathology results came back and he is NED which is great news.  The problem is that food is going right thru him, any advice would be great.

     

    Thanks Louise L

    Glad to Hear

    Hi Louise,

     

    I'm glad to hear your dad came through the surgery ok and is NED.  This is big deal surgery and comes with complications as SOP.  The important thing is that he is NED.  Good doctors can help work through the complications.  When you say food is going straight through, I assume you mean diarreah.  That wasn't a surgical side effect for me, but I've been on the same chemo for three years now and it is certainly a side effect of that.  My docs have me on a four pronged approach to it.  I'll just list what I do and you can place any value to your dad on it that you like.  

     

    I take 1-2 Lomotils up to 4x a day.  I take 1-2 Immodiums up to 4x a day.  I get an injection of sandostatin every two weeks.  Also, I got switched from Creon to Zenpep b/c my doc says it has better anti-diarreah qualities.  The Zenpep is for other purposes, but my dr said it'll perform the same function as the Creon, and will hopefully help.

     

    Hope this is useful, and congrats on the NED<

     

    Edl

     

  • paul61
    paul61 Member Posts: 1,392 Member
    #8
    Louise L said:

    Eating Issues

    Dad had Surgery on November 20,  Everything went well was in hospital for 2 weeks and just came home yesterday. Dad also had part of his colon removed as cancer was found there from a previous CT scan. so he is dealing with 2 surgeries in one.  Pathology results came back and he is NED which is great news.  The problem is that food is going right thru him, any advice would be great.

     

    Thanks Louise L

    Dumping Syndrome

    Louise,

    Unfortunately one of the common side effects of gastric surgery is something called “dumping syndrome” it is caused when undigested food moves to quickly from your Dad’s resected stomach into his small intestine. The small intestine tries to deal with the food by pulling water from the body to dissolve it. This causes dizziness, nausea, and diarrhea. These symptoms will resolve in time as your Dad’s body adjusts to his new digestive system and he learns what foods his new digestive system can deal with and what foods he must avoid. In the meantime there are some short term actions that can be taken to reduce the “dumping” events.

     

    Here is a reference that talks about foods to avoid and foods that work better than others:

     http://www.upmc.com/patients-visitors/education/nutrition/pages/dumping-syndrome-diet.aspx

    I assume your Dad’s surgeon give him a dietary guide to follow as he recovered from surgery but just in case please find below a recommended diet for post esophagectomy patients:

     http://www.upmc.com/patients-visitors/education/nutrition/pages/esophagectomy.aspx

     

    Some “rules” to follow that help include:

     1. Eat frequent small meals (every two hours)

     2. Chew all food very completely and eat slowly

    3. Avoid foods high in sugar content

    4. Avoid drinking large amounts with meals

    5. Avoid soups and food with sauces

    6. Sit down and rest for at least 15 minutes after eating

    7. Drink water an hour before or after meals to avoid dehydration

    And as observed above medications like lomotil or Imodium can be helpful in the short term as well.

     I know it is frustrating but it does usually resolve in a few months. I know that seems like a long time but recovery from surgery this major does take time.

     I hope your Dad feels better soon.

    Best Regards,

    Paul Adams

     McCormick, South Carolina

    DX 10/2009 T2N1M0  Stage IIB - Ivor Lewis Surgery  12/3/2009 - Post Surgery Chemotherapy 2/2009 – 6/2009
    Cisplatin, Epirubicin, 5 FU - Four Year Survivor

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