Minimally-Invasive Surgery Offers Greater Options For Esophageal Cancer

By Fran Berger - Beth Israel Deaconess Medical Center correspondent

For the 16,000 people who are diagnosed each year with cancer of the esophagus - the tube that carries food from the mouth to the stomach - the surgery many face is complicated. It often involves major incisions to open the chest, abdomen and neck in order to remove the esophagus and craft a new tube, fashioned from the stomach.

For the past seven years, surgeons at Beth Israel Deaconess Medical Center (BIDMC) have been developing and implementing minimally-invasive procedures to reduce the size of incisions necessary to perform the complex operation.

"The idea was that we can do this less invasively and that patients would get better, faster," says Dr. Jonathan Critchlow, BIDMC's Associate Chief of General Surgery.

Dr. Critchlow and his team work hand-in-hand with doctors in BIDMC's department of gastroenterology to treat patients with esophageal disease, who come to them with symptoms such as bleeding, difficulty swallowing and hoarseness.

In pre-cancerous conditions or early stages of cancer, patients often undergo endoscopic procedures to detect and remove lesions in the esophagus.  "By inserting a tube with a camera attached, our GI doctors are able to discover whether there is deeper cancer lurking and that helps us decide on our surgical procedures. If no invasive cancer is found, treatment may be purely endoscopic."

Dr. Critchlow says if the removal of the esophagus is indicated, there is no singular way to perform the operation. "There isn't one perfect incision that will get you where you want to go and deciding on the procedure used depends on the skill and training of particular surgeons."

In minimally-invasive procedures, a laparoscope with camera is inserted through small incisions and transmits pictures from inside the body to a video monitor, allowing surgeons to see and operate without large painful incisions.

Minimally-invasive procedures at BIDMC are done with small incisions in the chest, abdomen and sometimes neck.

One procedure used allows for incisions to be made in only the neck and abdomen and the work in the chest area to be done from above and below, while viewing the images on the screen.

"We have good instruments that afford us a magnified view of the stomach so we can free it up from its attachments, form a tube and connect it to the neck without directly cutting into the chest," says Dr. Critchlow.

The minimally-invasive surgery is a lengthy one, says Dr. Critchlow.  "We usually perform it with a team of two expert surgeons from the divisions of minimally invasive and thoracic surgery.  Each one brings their specialty to the table and it keeps the length of time in the operating room down."

It is difficult to gather comparative data on all surgical techniques, since randomized trials can't be conducted, says Dr. Critchlow.  "Some patients may, by the time we see them, have already undergone radiation or chemotherapy or other procedures.  It's like comparing apples and oranges."

There is evidence, however that "those undergoing the minimally-invasive procedures get their energy back quicker and are more active.  There has been discussion that there may be a lower incidence of pneumonia, as well, but not everyone agrees that is true."

Dr. Critchlow says minimally-invasive surgery is now the procedure of choice.

"We use it on all who are decent candidates for the surgery and we do very few open esophagectomies anymore."

Minimally-invasive surgical techniques are greatly improving the options, he says, and "we are enthusiastic about it."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.