Minimally Invasive Surgery

An esophagectomy for cancer involves removing most of the esophagus and replacing it with the stomach with the goal of curing the patients of cancer and allowing them to eat. Minimally invasive surgery involves operating through small incisions with the use of specially designed instruments and cameras. The minimally invasive esophagectomy (MIE) procedure was developed in the past decade but is only performed at several specialized centers in the nation. The procedure involves laparoscopy and video-assisted thoracoscopic surgery (VATS) to remove the esophagus and replace it with the stomach. Early results of the technique suggest a shorter hospital stay and fewer complications when compared with an esophagectomy done through larger incisions.

Chemotherapy and Radiation

When staging of esophageal cancer reveals involvement of the lymph nodes, then appropriate treatment may be chemotherapy and radiation to shrink the tumor. The esophageal cancer would then be staged again with CT scan, EUS (endoscopic ulstrasound) and possibly PET (Positron Emission Tomography) scan to determine whether an esophagectomy could be done to potentially cure the patient.

Other Treatment Options

Palliation of Esophageal Cancer

Approximately one-half of patients with esophageal cancer are never candidates for an esophagectomy and they may be treated with chemotherapy and/or radiation. The cancer however may cause blockage in the esophagus and make it difficult to swallow. Chemotherapy and radiation may help improve this problem, but minimally invasive endoscopic therapies are also available to improve swallowing. Some of the techniques include endoscopic laser treatment e.g., photodynamic therapy (PDT), and endoscopic stent placement. A large study of over 200 patients treated with (PDT) for palliation of dysphagia resulted in improved swallowing 85% of the time.