Our Summary

This research paper studied the impact of the COVID-19 pandemic on surgeries for esophageal cancer. It compared surgeries performed from March to June 2020 (during the pandemic) with those performed in 2019. The researchers were interested to see if the pandemic caused delays to surgery and if this resulted in worse outcomes for patients.

The study found that there were fewer surgeries performed during the pandemic (37) compared to 2019 (96). However, the time patients waited for surgery after their final treatment was similar in both periods. The study also found no increase in the severity of the cancer at the time of surgery (upstaging) during the pandemic compared to 2019.

Interestingly, there were fewer complications during the pandemic compared to 2019. The rate of readmission to the hospital was also not significantly different between the two periods. Importantly, none of the patients who had surgery during the pandemic died during their operation or contracted COVID-19.

The study concluded that surgery for esophageal cancer was not associated with worse outcomes during the pandemic, and there was little risk of COVID-19 infection when careful guidelines were followed. It recommended that surgeries for esophageal cancer should be prioritized to avoid delays.

FAQs

  1. Did the COVID-19 pandemic cause delays in surgeries for esophageal cancer?
  2. Was there a difference in the severity of esophageal cancer at the time of surgery between 2019 and during the pandemic?
  3. Did patients who had surgery for esophageal cancer during the pandemic experience worse outcomes or a higher risk of contracting COVID-19?

Doctor’s Tip

One helpful tip a doctor might tell a patient about esophagectomy is to carefully follow all pre-operative instructions provided by the medical team. This may include refraining from eating or drinking for a certain period of time before surgery, as well as any other specific preparations that need to be made. By following these instructions, patients can help ensure the success of their surgery and reduce the risk of complications.

Suitable For

Esophagectomy is typically recommended for patients with esophageal cancer who have not responded to other treatments such as chemotherapy or radiation therapy, or for those whose cancer has spread beyond the esophagus. Patients with early-stage esophageal cancer, as well as those with advanced-stage cancer who are otherwise healthy and able to tolerate surgery, may also be recommended for esophagectomy.

Additionally, esophagectomy may be recommended for patients with certain benign conditions of the esophagus, such as severe gastroesophageal reflux disease (GERD) or Barrett’s esophagus with high-grade dysplasia, that have not responded to other treatments.

Overall, the decision to recommend esophagectomy is based on a variety of factors including the stage and location of the cancer, the patient’s overall health and ability to tolerate surgery, and the potential benefits and risks of the procedure. It is important for patients to discuss their individual situation with their healthcare team to determine the most appropriate treatment plan.

Timeline

Before esophagectomy:

  • Patient undergoes various diagnostic tests such as endoscopy, CT scans, and biopsies to confirm esophageal cancer diagnosis.
  • Patient may undergo neoadjuvant therapy such as chemotherapy and/or radiation therapy to shrink the tumor before surgery.
  • Patient may need to undergo preoperative assessments and consultations with a multidisciplinary team including surgeons, oncologists, and nutritionists.
  • Patient may need to follow a special diet or make lifestyle changes to prepare for surgery.

After esophagectomy:

  • Patient undergoes surgery to remove part or all of the esophagus, as well as nearby lymph nodes.
  • Patient spends time recovering in the hospital, which can range from a few days to a few weeks depending on the type of surgery.
  • Patient may experience side effects such as difficulty swallowing, reflux, and weight loss after surgery.
  • Patient undergoes follow-up appointments and may need to undergo additional treatments such as chemotherapy or radiation therapy.
  • Patient may need to make long-term lifestyle changes such as dietary modifications and regular follow-up appointments to monitor for recurrence or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about esophagectomy include:

  1. What is the reason for recommending esophagectomy as a treatment option for my esophageal cancer?
  2. What are the potential risks and complications associated with esophagectomy?
  3. How long will the recovery process be after the surgery, and what can I expect in terms of pain and discomfort?
  4. Will I need any additional treatments, such as chemotherapy or radiation therapy, after the surgery?
  5. How many esophagectomy procedures have you performed, and what is your success rate?
  6. What is the likelihood of the cancer returning after the surgery, and how will it be monitored?
  7. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  8. Are there any alternative treatment options for my esophageal cancer that I should consider?
  9. How will my quality of life be impacted after the surgery, and are there any long-term side effects I should be aware of?
  10. How has the COVID-19 pandemic affected esophagectomy surgeries, and what precautions will be in place to ensure my safety during the procedure?

Reference

Authors: Dolan DP, Swanson SJ, Lee DN, Polhemus E, Kucukak S, Wiener DC, Bueno R, Wee JO, White A. Journal: Semin Thorac Cardiovasc Surg. 2022 Autumn;34(3):1075-1080. doi: 10.1053/j.semtcvs.2021.06.022. Epub 2021 Jul 1. PMID: 34217786