Is surgery typically recommended if there was a complete response to chemoradiation?

Dear Carrie:

Clinical trials have shown that the “tri-modal” treatment for Esophageal Cancer is best.  My husband was diagnosed with EC, Stage III (T3N1M0).  The very first thing our surgeon told us was that “even though the pre-op chemo/rad treatments may show total eradication, surgery is necessary.”  The reason being, scans are not 100% foolproof in the detection of cancer.  There could still be residual cancer that was not detected by the scan.  It is not unusual for surgeons to find more cancer during surgery than was first shown on the PET/CT scans after treatments. 

We were also informed that lymph nodes would be removed and examined for cancer during the surgery.  And, if even one node tested positive for cancer, that post-operative chemotherapy would be necessary. 

So by all means, neo-adjuvant (before) chemo/radiation and then surgery is the prescribed mode for longest survival.

And although you didn’t ask, the Ivor Lewis MINIMALLY INVASIVE ESOPHAGECTOMY is the least invasive type of Esophagectomy (totally laparoscopic) and has the quickest recovery after surgery because there are no massive incisions that have to heal.

Now when a patient has been diagnosed with Esophageal Cancer, it’s always best to have a second opinion. I trust you have had one.   My husband had his chemo/radiation here at home, but he had his SECOND OPINION at the University of Pittsburgh Medical Center.  A MIE was performed there by Dr. James D. Luketich in May of 2003. 

My husband, William, is now into his 14^th year of survival without any recurrence, for which we thank the Lord.  That’s a miracle for sure.  So don’t take any chances—surgery is absolutely necessary, especially for a Stage III EC patient.  Life’s too precious to gamble with!

Sincerely,

Loretta Marshall (Wife of William)

Hello Carrie,

A common course of treatment from where you are is to do chemo/radiation, then an esophagectomy.  This is done even if the chemo/radiation appears to be completely effective.  I was 40 and diagnosed stage III.  We did chemo/radiation, then surgery, and then I did an extra round of bonus chemo, which was stronger than the initial chemo.  This was done even though the surgery revealed no evidence of cancer after the chemo/radiation.  I was 40, thus relatively young and strong, so I could take it.  Also, I was young and we weren't looking to beat the cancer back for just a few years, but for a few decades.  Aggressiveness was the order of the day in my case.  EC comes back frequently, and you want to do everything you can to increase your odds of fending off a recurrence.  I still had a recurrence a couple of years later, but I would still go the same route of aggressive treatment if I had it to do over again.  It sucks, for sure, but you only get one chance to do this, so I'd recommend going as aggresively as you can.  

Best Wishes,

Ed

CarrieN said:

Thank you

Thank you for the info. I am scheduled to move forward with an esophagectomy at the end of the month. Little nervous about it, but know it's a must! 

Carrie,

The surgery is a major big deal.  Many things are not the same for me as they were before the surgery.  It was still the course of action that offered me the best chance for a positive outcome and I would do it the same way again.  I wish you the best possible results from your surgery.  You're young and hopefully otherwise healthy and strong, so I'm optimistic that everything will go as well as possible for you.

Best Wishes,

Ed