Our Summary

This research paper looks at changes in how esophagectomy (surgery to remove part or all of the esophagus) is performed, the specialties of the surgeons performing these procedures, and the outcomes for patients. The study used data from the National Safety and Quality Improvement Program (NSQIP) and included over 10,000 esophagectomies performed between 2007 and 2017.

The researchers found that the Ivor Lewis approach (a two-stage operation with an abdominal and chest incision) is becoming more popular, with the number of these procedures increasing from 37% in 2007 to over 62% in 2017. Meanwhile, the number of transhiatal esophagectomies (a less invasive surgery performed through the abdomen and neck) decreased from 41% to 21.5% during this time period.

The study also found that the transhiatal approach was more often used in patients who were already at a higher risk of death or complications. The number of these surgeries performed by cardiothoracic surgeons (specialists in surgery of the heart, lungs, and other organs within the chest) increased considerably over the study period.

In terms of complications, the study found that the Ivor Lewis approach had slightly lower rates of complications and surgical site infections compared to the transhiatal and McKeown (a three-part surgery involving an abdominal, chest, and neck incision) approaches. However, when the researchers took into account the patients’ risk factors, they found that the surgical approach didn’t significantly affect complication rates.

In conclusion, the Ivor Lewis approach has become the most common method for esophagectomy in the US and may have slightly lower complication rates. The McKeown approach has stable usage but might be associated with higher complications.

FAQs

  1. What are the different approaches to performing an esophagectomy and how have these trends changed over time?
  2. How does the surgeon’s specialty affect the outcomes of esophagectomy procedures?
  3. What factors are associated with the outcomes and complications of esophagectomy procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about esophagectomy is to follow post-operative care instructions closely, including proper wound care, pain management, and dietary restrictions. It is important to attend all follow-up appointments and notify your healthcare provider of any concerning symptoms or complications. Proper care and monitoring can help optimize recovery and minimize risks of complications.

Suitable For

Esophagectomy is typically recommended for patients with esophageal cancer or other conditions affecting the esophagus that cannot be treated with less invasive methods. Patients with a higher baseline probability of mortality or morbidity may be more likely to undergo a transhiatal esophagectomy, while those with lower risk profiles may be candidates for other approaches such as Ivor Lewis esophagectomy. Surgeons specializing in cardiothoracic surgery are increasingly performing esophagectomies, and the choice of surgical approach may impact complication rates. Overall, esophagectomy is a complex procedure that should be carefully considered for each individual patient based on their specific condition and risk factors.

Timeline

Before esophagectomy:

  • Patient undergoes diagnostic tests such as endoscopy, biopsy, and imaging studies to confirm the need for surgery.
  • Patient may undergo neoadjuvant therapy such as chemotherapy or radiation therapy to shrink the tumor before surgery.
  • Patient meets with a multidisciplinary team including surgeons, oncologists, and nutritionists to plan the surgery and post-operative care.

After esophagectomy:

  • Patient undergoes the surgical procedure, which may be performed using different approaches such as Ivor Lewis, McKeown, or transhiatal esophagectomy.
  • Patient is closely monitored in the intensive care unit (ICU) immediately following surgery to manage pain, prevent complications, and ensure proper healing.
  • Patient gradually progresses from a liquid diet to soft foods and eventually solid foods as they recover.
  • Patient may undergo post-operative chemotherapy or radiation therapy to further treat the cancer.
  • Patient attends follow-up appointments with their healthcare team to monitor for any signs of complications or recurrence of the cancer.

What to Ask Your Doctor

  1. What is the recommended approach for my specific case - Ivor Lewis, transhiatal, or McKeown esophagectomy?
  2. What are the potential risks and complications associated with each type of esophagectomy?
  3. How experienced are you and your team in performing esophagectomies, specifically the approach recommended for me?
  4. What is the expected recovery time and post-operative care for the recommended esophagectomy approach?
  5. Are there any alternative treatments or less invasive options available for my condition?
  6. How will my quality of life be affected after the procedure, and are there any long-term effects to consider?
  7. What is the success rate for this type of surgery in terms of cancer removal or symptom relief?
  8. How often will I need follow-up appointments and monitoring after the surgery?
  9. What lifestyle changes or dietary restrictions should I expect after the procedure?
  10. Are there any support groups or resources available for patients undergoing esophagectomy?

Reference

Authors: Zheng R, Tham EJH, Rios-Diaz AJ, Grenda TR, Evans NR 3rd, Rosato EL, Palazzo F, Berger AC. Journal: J Surg Res. 2020 Dec;256:103-111. doi: 10.1016/j.jss.2020.06.008. Epub 2020 Jul 16. PMID: 32683050