The Thoracic Surgery Division at Mount Sinai offers a minimally invasive approach to both malignant and benign diseases of the esophagus. For diagnosis of cancer of the esophagus we work with a team of specialists to diagnose and stage the cancer with endoscopy, endoscopic ultrasound and CT and PET scans. For treatment we discuss cases in Thoracic tumor board conferences with medical oncologists, radiation oncologists, gastroenterologists and the thoracic surgeons. For postoperative care we have endocrinologists and dieticians to optimize nutritional status so patients can heal as quickly as possible and minimize the risk of complications.

Areas of expertise at Mount Sinai for treatment of early-stage esophageal cancer unique in the New York area include a totally minimally invasive esophagectomy with laparoscopy and thoracoscopy (video-assisted thoracic surgery or VATS) as well minimally assisted with thoracoscopy (VATS) and laparotomy. Several published studies have suggested that patients have less pain, fewer complications and shorter hospital stays with a minimally invasive approach for this major operative procedure. Thoracic surgeons who perform this procedure have undergone an additional fellowship in advanced minimally invasive thoracic surgery. Mount Sinai is one of the few centers in the tri-state area with thoracic surgeons capable of performing this advanced surgical procedure.

Unfortunately, many patients with advanced esophageal cancer are not candidates for an esophagectomy but do have dysphagia (difficulty swallowing) or bleeding from their cancer. Mount Sinai’s thoracic surgeons offer several methods of palliating malignant dysphagia to allow patients to maintain nutrition by mouth. Endoscopic stents and laser treatments are placed by the thoracic surgeons and when necessary because of the site of the tumor, a bronchoscopy is also performed by the thoracic surgeon at the same time to assess the airway. This allows one-stop treatment and management for a problem without seeing several different specialists (gastroenterologists and pulmonologists for the same problem). After relief of dysphagia we work with the endocrinologists and dieticians to maximize nutritional status. Our thoracic surgeons also perform a laser treatment not available at all many other centers in the tri-state area: photodynamic therapy (PDT) or a thermal laser can be used endoscopically to improve dysphagia and to control bleeding from an esophageal cancer. Again our minimally invasive thoracic surgeons can manage multiple problems associated with esophageal cancer.

Areas of expertise for treatment of benign esophageal diseases include laparoscopy for treatment of gastroesophageal reflux disease (GERD) and hiatal hernias, repair of giant paraesophageal hernias with stomach and other intra-abdominal contents in the chest and treatment of achalasia, a rare motility disorder of the esophagus. Other uncommon problems of the esophagus including diverticuli and leiomyoma are treated with laparoscopy or thoracoscopy (VATS) by the Thoracic Surgeons at Mount Sinai. Re-operative surgery for benign esophageal disease can also be approached minimally invasively thus not committing the patient to larger incisions, increased pain and longer recovery.