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Esophageal Cancer

About Esophageal Cancer

Esophageal cancer is a treatable disease, with most esophageal cancers are either adenocarcinoma or squamous cell carcinoma.

Diagram of thoracic area of human body, including esophagus, trachea, lungs, heart, diaphragm, and stomachSquamous Cell Carcinoma

  • most common type of esophageal cancer
  • usually occur in the upper and middle part of esophagus
  • squamous cells line the esophagus

Adenocarcinoma

  • usually occur in the lower part of esophagus
  • develops in glandular tissue
  • normally part of inner lining of esophagus
  • glandular cells replace an area of squamous cells to form adenocarcinoma
  • many adenocarcinomas of the esophagus are associated with Barrett's Disease, although most patients with Barrett's esophagus do not develop cancer of the esophagus

 

Treatment for Esophageal Cancer

As with many cancers, chances for recovery is best if treated early. Since esophageal cancer often is not diagnosed early, by the time it is detected it has already spread throughout esophagus and beyond.

Esophagectomy

  • surgery to remove all or a portion of esophagus
  • lymph nodes will also be removed
  • upper part of esophagus is reconnected to stomach; stomach is raised higher into the chest area to compensate for the missing portion of the esophagus
  • if the cancer is located toward the lower portion of the esophagus and near the stomach, or where the esophagus and stomach join, surgeon will remove part of the stomach and part of the esophagus with the cancerous cells
  • if cancer has not spread beyond esophagus, removing the esophagus may be able to cure the cancer
  • surgery can also be recommended as a palliative measure, to ease pain, help reduce symptoms including trouble with swallowing, and to make it easier for the patient to eat and maintain a healthy diet

Related link: Robotic Esophagectomy for Esophageal Cancer at USC Department of Surgery

 

Video: Vagal Sparing Esophagectomy

Above: Dr. Lipham performing a minimally invasive vagal sparring esophagectomy. This is a procedure that removes the diseased esophagus while preserving the vagus nerves which are important in respiratory and GI function. This procedure is intended for patients with Barrett's with High Grade Dysplasia, early esophageal cancer and benign end stage disorders of the esophagus.

 

Outcomes Following Laparoscopic Transhiatal Esophagectomy
for Esophageal Cancer

By J. Christian Cash, Bobak Hedayati, Nikolai A. Bildzukewicz, Namir Katkhouda, Rodney J. Mason, John C. Lipham

Abstract

Background
Most published minimally invasive esophagectomy techniques involve a multiple field approach, including laparoscopic and thoracoscopic esophageal mobilization. Laparoscopic transhiatal esophagectomy (LTE) should potentially reduce the complications associated with thoracotomy. This study aims to compare outcomes of LTE with open transhiatal esophagectomy (OTE) and en-bloc esophagectomy (EBE).

Methods
Retrospective chart review was performed on all patients who had an LTE for cancer between July 2008 and July 2012 at our institution. Data was compared with an historic cohort of patients who underwent OTE and EBE at the same institution from July 2002 to July 2008.

Results
There were 33 patients with LTE, compared with 60 patients with OTE and 139 with EBE. The presence of minor operative complications was similar (p = 0.36), but major complications were significantly less common in the LTE group (12, 23 and 33 %, respectively; p = 0.04). The median number of blood transfusions during hospitalization was significantly lower in the LTE group (0, 2.5 and 3, respectively; p = 0.005). Median tumor size was significantly smaller (1.5, 2.2, and 3 cm, respectively; p = 0.03), but the LTE group had a significantly higher percentage of patients with neoadjuvant treatment (39, 14 and 29 %, respectively; p = 0.008). Median lymph node yield for LTE was lower (24, 36 and 48, respectively; p\0.0001), but the percentage of patients with positive nodes was similar (33, 33 and 39 %, respectively; p = 0.69). Mortality was equivalent among the groups (0, 2 and 4 %, respectively; p = 0.38). The median LOS for the LTE group was significantly lower (10, 13 and 15 days, respectively; p\0.0001). Overall survival was not different between the three groups (p = 0.65), with median survival at 24 months of 70, 65 and 65 %, respectively.

Conclusion
LTE can be performed safely with less major complications and shorter hospital stay than open esophagectomy. The reduced lymph-node harvest did not impact overall survival.

View / download complete paper (PDF file, 296KB)

 

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