Esophagectomy, the surgical removal of the esophagus, includes a number of different variations. The type of esophagectomy a patient undergoes depends on the stage of cancer as well as physical condition and other medical conditions he or she may have.
Minimally invasive esophagectomy (MIE) was popularized by James Luketich, M.D., at the University of Pittsburgh. At the Swedish Cancer Institute, MIE is used with patients who have early esophageal adenocarcinoma and for selected Stage II patients. Surgeons perform the procedure using small one centimeter incisions on the right chest, abdomen and left neck. They operate with specially designed instruments while viewing images of the patient on high definition screens. With this technique, patients recover slightly faster than with traditional approaches and have less pain.
Transhiatal esophagectomy was developed by Mark Orringer, M.D., at the University of Michigan. At the Swedish Cancer Institute, it is used with patients who have early esophageal adenocarcinoma, selected stage II patients and elderly patients who are not physically able to undergo larger operations. The procedure is performed using an abdominal incision and a left neck incision. At Swedish, we often with combine this procedure with a minimally invasive approach in the chest or to perform a vagal sparing esophagectomy.
Vagal-sparing esophagectomy (VSE) was developed by Dr. Akiyama in Japan, and refined by Tom Demeester, M.D., at USC. Surgeons at Swedish are some of the only experts in the country trained in this technique. VSE can help avoid the complications associated with division of the vagal nerves during standard esophagectomy. This operation is intended for patients with non-cancerous disease such as achalasia, Barrett's esophagus or early esophageal cancer.
This procedure is performed with incisions on the abdomen and neck or with small minimally invasive camera incisions. The vagus nerves are preserved in this operation, which allows the stomach to function more normally and avoids some of the common gastrointestinal side effects of a standard esophagectomy.
En Bloc or Radical Esophagectomy was developed by Tom Demeester, M.D., at USD, and Dr. Skinner, to improve the outcome of patients with locally advanced esophageal cancer. While most patients with this type of esophageal cancer can undergo this radical surgery, it is a demanding operation. At the Swedish Cancer Institute, we offer en bloc esophagectomy to patients who have Stage II and III esophageal cancer who are physically able to undergo this operation.
Although a demanding operation, the results from this operation in multiple centers have higher survival rates and small local recurrence rates compared to other types of esophagectomy when used for patients of similar stages. When combined with chemotherapy and radiation, this offers patients with advanced Stage III disease the best opportunity for cure and it offers the best chance of cure with only surgery for patients with Stage II disease.
In the video below, Thoracic Surgeon Dr. Brian Louie discusses the procedures described above to treat esophageal cancer.