"Esophageal cancer is a deadly disease. If it is detected late, the overall survival rate is low. Our goal at USC is to provide the best opportunity for cure. Our experience has been that if we identify the patients with early disease, we can make a significant impact on their survival with a more aggressive or extensive resection", explains Jeffrey A. Hagen, M.D. This operation, called an en-bloc resection, involves removing the esophagus and tumor surrounded by normal tissues, and a systematic resection of potentially involved lymph nodes in the chest and abdomen. A portion of the patient's colon is then used to reconstruct the esophagus.

Reconstruction of a destroyed esophagus from longstanding disease enables the patient to enjoy an improved quality of life. A section of colon is removed, the colon sutured together, and the removed colon sewn between the esophagus in the neck and lower stomach to replace a portion of the esophagus.

"Since we do not have to preserve stomach to act as the neo-esophagus, this more aggressive technique also allows the surgeon to remove more of the stomach, providing a wider margin from the tumor and minimizing the chances of a recurrence," Dr. Hagen notes. This more extensive cancer surgery is a challenge to both physician and patient, but has resulted in improved survival for many patients with esophageal cancer. However, the complexity of the operation makes it essential that the procedure only be done in centers such as USC that have substantial experience with esophageal cancer.

A more palliative operation, called a transhiatal esophagectomy, involves two incisions-one in the abdomen and one in the neck. The esophagus is bluntly dissected from above and below through these incisions, and then removed. A small piece of the esophagus is left in the neck, where it is then sewn to a tube created from the stomach. This operation focuses on removing the tumor in the esophagus to relieve the obstruction and restore swallowing. Our goal with transhiatal esophagectomy is to remove the tumor and thereby relieve the obstructive symptoms, enhance the quality of life, and provide hope for cure.