Surgery options (?) for cancer of the oesophagus

Hi

My surgery was six years ago at Addenbrookes in Cambridge. It was a standard radical Ivor Lewis (not minimal invasive). 
When the surgery proposed was explained to me I was shocked! When I asked about minimal invasive surgery the surgeon said he didn’t do it but there were some surgeons that did. He said that in order to approach being an expert in any technique he reckoned you needed to have performed it 50 times. So that was something for me to consider when I, like you, looked for less radical options.

I hope you can find answers to your query. Remember there is no one on the forum who can give advice, we can only share information and experience.

Brent,

Thanks for the response. (And I fully note the caution in your final paragraph.)

Just to clarify the terminology, when you refer to 'minimal invasive surgery', did you mean things like 'keyhole' surgery rather than traditional open surgery? Or were you referring to the entire scope of the surgery (i.e. exactly how much of the oesophagus/stomach was excised)?

Thanks.

PS: Further to clarify - what exactly is meant by 'radical Ivor Lewis'? (Or, specifically, the 'radical' part of that phrase?)

Thanks!

Hi, I had a look at the link you posted. I had the Ivor Lewis surgery at Edinburgh Royal Infirmary performed by Mr Couper who did a brilliant job. I had pretty much what was pictured in the link, keyhole surgery on the abdomen and my new smaller stomach was behind my right lung. However the entry scar on my right side is longer than 4cm. I would say it's approximately 12 inches, they removed 2 ribs and deflate the right lung so they can guddle about with your oesophagus and stomach. That was in October 2016 and like Brent I am still here and enjoying life. I never thought I would be able to eat normally again. I was 57 kgs when I left hospital, I had lost about 5 stones prior to surgery. I am now 100 kgs and I intend to start losing weight and dieting. I never thought I would gain weight like this, although my consultant surgeon and GP are amazed that I have gained so much. Apparently many people struggle to gain weight and sustain it. Good luck to you and your wife and feel free to ask anything, kind regards Frank.

Yes, by minimal invasive I mean keyhole.

in the pictures from the Stanford paper they show a partial oesophagectomy where only the lower part of the oesophagus is removed (by in this case keyhole surgery). By radical I am meaning where the whole of the oesophagus is is removed, and the new oesophagus formed by the slimmed down stomach is pulled through into the thorax, above the diaphragm. Strangely all these are called after Ivor Lewis who invented this procedure in the middle of the last century!

I had an “open” Ivor Lewis - leaving me with a large scar across by abdomen, just under my ribs, and a “shark bite” scar down the right side of my back, following the line of a rib which was displaced while they operated, plus a couple of impressive “stab wounds” where chest tubes were inserted. I’m no less beautiful than I was before, but more interesting!

Brent, Zappaman,

Thanks very much for those replies - I appreciate both.

I will have a final chat with the surgical team involved to get things clear in my head. What puzzled me at first is that the Macmillan booklet on this type of cancer suggests that a total oesophagectomy is not the usual option, but I gather now that it might be.

In any event I obviously trust their judgement in deciding the best surgical approach.

I expect that I will be posting back in this forum in due course for some more help with post-operative recovery and adjustments.

Thanks again.

Hi PTP,

Sorry that your wife has cancer of the oesophagus.

The goal of the surgery is to remove the tumour with safe margins. The problem is to reach the base of the oesophagus and / or stomach is non trivial. 

The common (tried tested and proven) solution is Ivor Lewis surgery. I thought I had this in August 2018, but I noticed my scar (about 12 inches long) is on my left side not my right side. At one of my checkups I queried this and was told I had "laparoscopic assisted left thoracoabdominal oesophagectomy" surgery. I assume this was because during the staging process a lump (not malignant) was found in my right lung and they didn't want to risk deflating it for 5-10 hours?

Anyway my treatment was successful and I'm now in remission. And lucky I went to a teaching hospital as I've been told that some hospitals only offer Ivor Lewis surgery. 

The surgery is major, but I recovered from it quite quickly and had good pain management. I had my first "pyloric stretch" last week about 18 months after surgery. I found the stretch painless (well I was sedated). 

Bottom line:-- There are several surgical procedures for gaining access to the oesophagus and stomach. But unless the tumour is removed with safe margins there is little point having surgery. You do recover from surgery. All the procedures are radical. Perhaps the safest (lowest risk) is the Ivor Lewis surgery that your surgeons will be most familiar with?

Wishing your wife a speedy and full recovery.

Anon613,

Thanks for that detailed reply; thanks for your good wishes; and I am very pleased to hear that things are working out well for you.

I fully understand the need to remove sufficient margins of tissue to try to ensure that the tumour cannot regrow in the same place - that is the last thing anybody would want.

When we first met the surgical team (which was only a few months ago, but which feels like a lifetime ago now!), I remember a comment being made that they had found that, in terms of post-operative quality of life, in general a better long-term outcome is achieved when a total oesophagectomy (in which the remaining stomach is raised completely above the diaphragm) is performed, rather than a partial one (in which part of the remaining stomach is raised above the diaphragm, and some remains below.) I can see that that would make sense: either way, you've lost the oesophageal/stomach sphincter (so the risk of the future occurrence of reflux etc. remains the same), and there would seem to be no particular advantage in 'constricting' what remains of the stomach by having it pinched by the diaphragm in that way.

One thing I'm getting out of all this is an accelerated lesson in anatomy! However, I am purely (and very obviously!) a layman in this matter. Before the operation takes place, we will have another chance to discuss exactly what the surgeons have in mind in our case.

Thanks for all the responses here, and all the best to everybody.