Esophageal Cancer Surgery

There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma.  The number of patients with adenocarcinoma has been rising over the last several years, particularly among white men.  At City of Hope, we personalize the surgical approach to provide the best treatment for the specific patient.

Chronic heartburn (gastroesophageal reflux disease) can lead to irritation of the lining of the esophagus.  Over time, this irritation can cause the cells to become pre-cancerous, a condition known as Barrett’s esophagus.  Through an endoscope (small, flexible camera that enters through the mouth), experts at City of Hope can destroy (ablate) this precancerous tissue, allowing the body to lay down a new layer of more normal cells.  We can also remove very early stage cancers with the endoscope, in a technique known as endoscopic mucosal resection.  These endoscopic treatments are outpatient procedures and do not require an overnight stay in most cases.  Patients recover very quickly and usually resume normal activities the next day.  For Barrett’s esophagus and early stage esophageal tumors, these endoscopic treatments are highly effective and have cure rates equivalent to traditional surgery.

Unfortunately, most esophageal cancers are found at a more advanced stage than can be treated with endoscopic therapies.  For these more aggressive tumors, we recommend a radical esophagectomy, which involves removal of most of the esophagus as well as some of the stomach.  Many patients receive a combination of treatments with chemotherapy and radiation before surgery.  In most cases, City of Hope surgeons perform radical esophagectomy using minimally invasive, robotic techniques.

 

Compared to traditional esophagectomy which requires a large abdominal incision, a large chest incision with rib spreading, and sometimes a neck incision, minimally invasive esophagectomy has been shown to cause less pain, less blood loss, a faster recovery, and fewer complications. There is no difference in the risk of cancer recurrence.