COLUMBUS, Ohio – A minimally invasive approach to treat cancer of the esophagus is bucking conventional wisdom by giving surgeons a better view of a patient’s chest and abdomen than that offered by traditional open surgery.
The Ohio State University Medical Center is among the few institutions in the United States offering a procedure called a minimally invasive esophagogastrectomy. Surgeons use endoscopic tools and cameras inserted through nine very small holes in the chest and abdomen to conduct the surgery, and are able to remove most of the esophagus, one-third of the stomach and draining lymph nodes, all through an incision in the neck that’s no more than 2 inches long.
“People often ask how we do this without having to open the chest and abdomen,” said Dr. Abbas E. Abbas, a cardiothoracic surgeon at OSU Medical Center specializing in treatment of esophageal cancer patients. “Interestingly, we can see even better inside because we have magnification and long cameras that can go to places a surgeon’s eyes just can’t see. It’s especially helpful to be able to see the regional lymph nodes, which are often very difficult to assess with open surgery.”
Conventional open surgery to treat esophageal cancer involves three large incisions – between 15 to 20 centimeters each – providing surgeons access to the abdomen, chest and the neck. In the chest it would also include spreading the ribs, which is not done with the new technique.
“Esophageal cancer traditionally has been a very difficult cancer to approach with any means of intervention,” Abbas said. “The traditional large incisions brought significant post-operative pain and were often accompanied by respiratory problems. It’s hard for patients to breathe after surgery because of the pain.”
In clinical trials to date, the minimally invasive option has reduced respiratory complications and pain and shortened hospital stays. OSU Medical Center is part of a multicenter trial sponsored by the National Cancer Institute’s Cancer and Leukemia Group B, which is designed to define criteria patients must meet to undergo minimally invasive surgery and to compile more data on results. But Abbas said patients may undergo the minimally invasive option at OSU Medical Center even without enrolling in the trial.
After removing the damaged parts of the esophagus, part of the stomach and lymphatics, surgeons reattach the stomach to a pouch at the top of the esophagus. The stretched stomach rests in the space left open by the removal of the esophagus and in effect becomes the patient’s new esophagus.
“Even though we use a minimally invasive technique, these patients are still undergoing a significant operation,” Abbas said. Doctors encourage patients to walk and talk within a day or two of surgery to take advantage of the reduced pain. And within one to two weeks, patients are expected to be able to experience normal swallowing and speech and to eat regular food.
“They can’t have the same large meals as before, so we encourage patients to eat multiple smaller meals throughout the day,” Abbas said.
The American Cancer Society estimates that during 2005, approximately 14,250 new esophageal cancer cases will be diagnosed in the United States. This disease is three to four times more common among men than among women and affects mostly white middle-aged men.# # #
Medical Center Communications